Medicare payments to hospitals double those to ASCs: 4 study notes

Medicare per-procedure payments to hospital outpatient departments were 2.1 times larger than payments to ASCs, according to new research published by the Rand Corp. 

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Researchers analyzed medical claims data from all states from 2018 to 2020. 

Four more stats:

1. Private insurer payments to hospital outpatient departments were 2.6 times larger than payments to ASCs.

2. ASC prices increased faster than Medicare payment rates — from 159 percent of Medicare rates in 2018 to 162 percent in 2020. 

3. Prices for common outpatient services performed in ASCs averaged 162 percent of Medicare payments, but the same outpatient services averaged 117 percent of Medicare when performed at hospital outpatient departments. 

4. Although relative claims are lower at ASCs, hospital outpatient department prices are higher than ASC prices.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.

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Is ambulatory care healthcare’s big margin engine? 4 leaders weigh in

Wednesday, July 29
1:00 PM - 2:00 PM CDT

Presenters: Joe Ganley, athenahealthJeffrey Flynn, CASC, Gramercy Surgery CenterBryan Tsao, Access Center, Loma Linda University HealthJason Zepeda, Northridge Hospital Medical Center, CommonSpirit HealthGreg DeConciliis, PA-C, CASC, Boston Out­Patient Surgical Suites

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