Increasing Medicare payments, number of ASC openings, closings & more: 54 takeaways from MedPAC report

MedPAC's 2019 commission report to Congress provided insight on a number of ASC metrics, including Medicare payment growth, facility statistics, the number of fee-for-service beneficiaries and service volume, among other metrics.

The key details to know:

Medicare payments to ASCs increased between 2012 and 2017.

Medicare payments (in billions of dollars)

1. 2012 - $3.6
2. 2016 - $4.3
3. 2017 - $4.6

Average annual change

4. 2012 - 2016 - 4.1 percent
5. 2016 - 2017 - 7.4 percent

Medicare payments per fee-for-service beneficiary

6. 2012 - $110
7. 2016 - $126
8. 2017 - $136

Average annual change

9. 2012 - 2016 - 3.5 percent
10. 2016 - 2017 - 7.7 percent

The change in the number of Medicare-certified ASCs from 2012 to 2017:

2012
11. New: 176
12. Closed or merged: 114
13. Total: 5,216

2016
14. New: 159
15. Closed or merged: 90
16. Total: 5,474

2017
17. New: 189
18. Closed or merged: 60
19. Total: 5,603

Average percentage change
20. 2012-2016: 1 percent
21. 2016-2017: 2.4 percent

The number of fee-for-service beneficiaries and service volume at ASCs increased between 2016 and 2017.

Volume of ASC services in millions
22. 2012: 6.0
23. 2016: 6.4
24. 2017: 6.5

Average annual change in ASC services
25. 2012 - 2016: 1.8 percent
26. 2016 - 2017: 1.4 percent

Volume per 1,000 FFS beneficiaries
27. 2012: 181.2
28. 2016: 190.1
29. 2017: 193.3

Average annual change in FFS beneficiary volume
30. 2012 - 2016: 1.2 percent
31. 2016 - 2017: 1.7 percent

Pain management ASCs grew most rapidly during the period covered by the report between 2015 and 2017. In 2017, there were 100 more pain management ASCs billing Medicare than in 2015.

Changing technology and clinical practices are contributing to the expansion of the types of procedures performed in ASCs. As this trend continues, more knee and hip arthroplasty procedures may be done in ASCs.

ASCs are more convenient for patients than hospital outpatient departments, according to MedPAC. Additionally, patients' coinsurance is lower in ASCs than HOPDs for procedures covered on the ASC payment system.

Value-based care and ASCs' low-cost settings make ASCs appealing investments for private equity firms and hospital systems.

The majority of ASCs billing Medicare in 2017 specialized in a single area. In 2017, 61 percent of ASCs were single-specialty and 40 percent were multispecialty.

The top ASC specialties:

32. Gastroenterology: 21 percent
33. Ophthalmology: 21 percent
34.Pain management: 8 percent
35. Dermatology: 4 percent
36. Urology: 3 percent
37. Podiatry: 2 percent
38. Orthopedics/musculoskeletal: 1 percent
39. Respiratory: 1 percent

The geographic distribution of ASCs is uneven, according to MedPAC data from 2017. The state that had the most ASCs per Medicare beneficiary was Maryland, with 40 ASCs per 100,000 Part B beneficiaries. Wyoming, Alaska and Georgia followed Maryland at approximately 20 ASCs per 100,000 Part B beneficiaries. Washington, D.C., West Virginia, Alabama and Vermont all had the fewest ASCs per beneficiary at four per 100,000 beneficiaries. According to the 2017 data, Vermont had only one ASC in the whole state.

2018 MedPAC provider services file data from CMS shows that most ASCs are for profit and urban:

For profit
40. Open in 2012: 93.6 percent
41. Open in 2017: 93.8 percent
42. New in 2017: 92.6 percent

Nonprofit
43. Open in 2012: 3.8 percent
44. Open in 2017: 3.5 percent
45. New in 2017: 5.8 percent

Government
46. Open in 2012: 2.7 percent
47. Open in 2017: 2.7 percent
48. New in 2017: 1.6 percent

Urban
49. Open in 2012: 92.5 percent
50. Open in 2017: 92.9 percent
51. New in 2017: 94.2 percent

Rural
52. Open in 2012: 7.4 percent
53. Open in 2017: 7.1 percent
54. New in 2017: 5.8 percent

Note: Some totals don't add up to 100 percent due to rounding.

More articles on benchmarking:
4 insights on how high healthcare costs burden Americans
4 things to know about Medicare payments to ASCs
Number of Medicare-certified ASCs that have opened, closed or merged over the past 4 years

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