CMS posts payments for ASCs vs. HOPDs — Medicare pays ASCs $359 less for colonoscopy, $1,092 less for knee arthroscopy

CMS has paved the way for price transparency between ASCs and hospital outpatient departments with a new tool that reveals the average payments for select procedures in both settings.

Here are five things to know:

1. The Procedure Price Lookup tool includes the national average payments to HOPDs and ASCs, as well as the average copay Medicare beneficiaries without supplemental insurance would pay in both settings.

2. The tool meets the requirement Congress set forth in the 21st Century Cures Act, which mandates CMS maintain separate payment systems for different types of healthcare providers. "The different payment rates are a prime example of Medicare's misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another," said CMS Administrator Seema Verma.

3. Procedure Price Lookup is part of CMS' recently launched eMedicine initiative, which includes an overhauled version of the agency's drug pricing and spending dashboards.

4. In some cases, the payments are similar, and in others there are big differences. For example, Medicare pays $390 for a colonoscopy in an ASC while it pays $749 for the same procedure in an HOPD. The average patient copay in an ASC is $98 while patients pay $187 on average in an HOPD.

5. Several orthopedic procedures are also listed in the database. For example, Medicare pays $1,024 for a knee arthroscopy with meniscus repair in an ASC, compared to $2,116 in an HOPD. Medicare beneficiaries without supplemental insurance have a copay of $256 in ASCs and $529 in HOPDs.


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