ASCs' reimbursement woes: What's worrying leaders in 2023

ASCs are historically reimbursed at lower levels than hospital outpatient departments, and as operating costs soar, many leaders are worried about how low reimbursements will affect their ability to meet margins. 

"[Hospital outpatient departments] offer the same hours as the ASC, with the added hospital benefits and increased wages," Sandra Berreth, RN, director of the Foothill Surgery Center at Sansum Clinic in Santa Barbara, Calif., told Beckers. "How can ASCs compete with that? Simply, we can't, so every day, we work at breakneck speed and efficiency, employing everything we know to maintain the cleanest environment and safest working conditions, and above all, we keep the patient safe, with the highest patient satisfaction rate in the industry."

Despite the inconsistency in reimbursements, Medicare payments for ASC's top 10 CPT codes are projected to increase by 3.9 percent in total in 2023, according to a report from VMG Health. 

Payers are also facilitating the migration of procedures to outpatient facilities. In June 2021, UnitedHealth Group made a commitment to push more surgeries to ASCs — the group aims to have more than 55 percent of its members' outpatient surgeries and radiology services delivered at cost-efficient sites of care by 2030.

Some leaders are worried the increase in payments isn't enough to combat rising inflation costs. 

"Payers continue to put downward pressure on ASCs, at a time when we are expanding services, and that tension makes all of our ASC partners nervous," Michael McClain, the executive director of ambulatory surgery at Renton, Wash.-based Providence, told Becker's. "As hospital ASC leaders, we need to be sure that we have both the clinical expertise and alignment in our ASCs as well as do our homework on the reimbursement piece."

Some leaders are looking to contract negotiations to abate this. 

"Reimbursements are not matching inflation rates," Adeel Faruki, MD, assistant professor of anesthesiology at University of Colorado Anschutz Medical Campus in Aurora, told Becker's. "I believe 2023 will be the year providers will fight harder for better rates in contracts with insurance companies. If negotiations don't go well, these providers may even opt out from certain contracts, resulting in more out-of-network providers for patients."

This can be tricky because in many markets, ASCs have to face competition from larger hospitals and health systems to secure payer contracts. 

"Most of my time is spent on payer negotiations and payer issues. I spend more time negotiating  with payers than I ever expected in this role," Jessica Rodriguez, administrator of OAM Surgery Center at MidTowne in Grand Rapids, Mich., told Becker's. "The payment landscape for ASCs is another big challenge that we face. Costs are going up exponentially, but we are not seeing a corresponding increase in reimbursement."

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