ASC vs. HOPD Reimbursement: 2014 Outlook & Trends

On Jan. 16, the Medicare Payment Advisory Commission recommended Congress give ASCs a 0 percent pay rate raise and a 3.25 percent percent raise for hospital outpatient departments.

This is the second straight year MedPAC has failed to recommend a pay raise for ASCs.

Even though MedPAC has suggested reducing pay differences between ASCs and HOPDs for some procedures, the commission still endorses significantly higher payments for hospital outpatient procedures.

ASCs have long been paid as a percentage of HOPD reimbursements, and that percent has declined steadily over the last decade. Here are five statistics on ASC vs. HOPD reimbursements, according to VMG Health's 2011 ASC Intellimarker Survey.

ASC reimbursement as a percentage of HOPD reimbursement:
2003 — 87 percent
2008 — 63 percent
2009 — 59 percent
2010 — 58 percent
2011 — 56 percent

According to 2011 MedPAC data, 14.2 percent of Medicaid patients were treated in ASCs, compared with 23.4 percent in HOPDs. There were 5,344 Medicare-certified ASCs in 2011, which included 153 new centers.

Risk scores of common procedures performed in ASCs vs. HOPDs:

Cataract procedure with IOL insert — 1.19
Lower GI endoscopy — 1.08
Level III nerve injection — 1.33
Colonoscopy — 0.90
Level I arthroscopy — 0.89

Cataract procedure with IOL insert — 1.24
Lower GI endoscopy — 1.22
Level III nerve injection — 1.34
Colonoscopy — 1.00
Level I arthroscopy — 1.00

ASCA action

In June 2013, a bipartisan group of Congressmen introduced the Ambulatory Surgical Center Quality and Access Act of 2013, a bill the Ambulatory Surgery Center Association supports to change the methods of setting rates for ASCs and HOPDs. The Ambulatory Surgery Center Association and state associations have hosted events to connect members of the ASC industry with their Congressional leaders to lobby for the bill, and several members of Congress have signed on with their support.

More Articles on Reimbursements:
Healthcare Reform: Impact on ASC Managed Care Contracting Next Year
ASC Ownership Trends: Are Physicians Making the Investment?
ASC Buyers & Sellers: Valuation in 2014

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