ASCs’ reimbursement problem 

ASCs are historically reimbursed at lower levels than hospital outpatient departments, despite being considered by many in healthcare to be a high-quality and low-cost site of care. 

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As operating costs soar, many leaders are concerned about how low reimbursements will affect their ability to meet margins. 

Here are five numbers illustrating ASCs’ reimbursement challenges:

3.1%. CMS’ finalized payment rate for ASCs in its 2024 final rule, a decrease from 2023’s 3.8% payment rate. 

58%. How much more medical procedures can cost at HOPDs as of 2022 when compared to a physician office or ASC, according to an analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association’s data analytics company.

10%. The percentage increase in the cost of a diagnostic colonoscopy at ASCs between 2017 and 2022, compared to 17% at HOPDs, according to the Blue Health analysis. 

33%. The amount by which adjusted reimbursement for GI procedures decreased on average from 2007 to 2022, according to a study published in the American Journal of Gastroenterology

55%. How much higher U.S. hospitals’ facility fees for colonoscopy procedures covered by private health insurance are than those at ASCs as of May 2023, according to a Johns Hopkins Bloomberg School of Public Health study published in JAMA Health Forum.

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