Time for ASCs to be reimbursed the same as hospitals, Prime Surgeons CEO says

Patsy Newitt - Print  |

Gil Tepper, MD, founder and CEO of Prime Surgeons in Los Angeles, spoke with Becker's ASC Review on changes he feels CMS should implement to give hospital outpatient departments and ASCs equal footing. 

Editor's note: This interview was edited lightly for clarity and brevity. 

Question: What's one regulatory change you wish CMS would implement to benefit ASCs/patient care?

Gil Tepper: CMS should change the reimbursement calculator on a basket of codes to put ASC and outpatient departments on a level playing field. They should use a transparent, unified fee schedule which applies equally to ASC and outpatient departments. They need to set a new reimbursement schedule that puts HOPD and private ASCs on equal footing.

Surgery centers, as small businesses, are clearly beneficial to the system — the success of ambulatory surgery as a discipline is critical to the benefit of the healthcare system in offloading the hospitals for more critical care. Today, the playing field is not level with reimbursement calculations using different indices between the outpatient department and the ASC — hospitals being reimbursed higher. This is a product of unfair and uneven lobbying size — with hospitals having much more representation on the lobbying side.

While putting patient safety front and center, this has the potential to create an actual incentive program for innovation. Surgeons who participate in ownership of ASCs will be motivated to evolve through the challenging and time-consuming investment it takes for responsible adoption of new techniques and technologies. 

CMS should also deliver a clear concise basket of codes for procedures that are well-established and peer-reviewed. This has a safety and systemic benefit. This will neutralize the "lobbying power" difference in play between hospitals and freestanding ASCs.

This change will empower the consumer to choose based on his/her specific information, understanding and circumstance the options for where a particular procedure may be carried out with equal safety. This will also offload the hospital traffic in a responsible way to open space for pandemic-related challenges that are better handled/reimbursed in hospitals.

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