While federal investigators are raising red flags about peripheral vascular procedures performed in office-based labs, the same data tells a different story for ASCs.
In May, the HHS Office of Inspector General released an investigation finding that physicians may be regularly performing medically unnecessary peripheral vascular procedures in office-based labs. The report scrutinized $548 million in Medicare Part B payments for procedures performed in OBLs in 2023 and estimated that roughly 19%, or $105 million, may have been medically unnecessary.
ASCs were largely absent from those concerns. Here are five takeaways from the OIG report and what they mean for ASCs:
1. ASCs received just $15 million of the $970 million Medicare paid for peripheral vascular procedures across all settings in 2023 — a fraction of what OBLs collected — suggesting the sector has significant room to grow its share of this market.
2. ASCs had lower rates of the two most scrutinized procedure types than OBLs. In 2023, 60% of ASC procedures included an atherectomy, compared to 75% in OBLs. Similarly, 35% of ASC procedures involved tibial arteries, compared to 47% in OBLs. Both procedure types have been flagged by professional guidelines and clinical researchers for potential overuse and poor outcomes.
3. The ASC share of peripheral vascular procedures is growing. Between 2019 and 2023, the percentage of these procedures performed in ASCs increased from 0.2% to 1.3%. While still a small slice of the market, that sixfold increase suggests physicians and patients are increasingly viewing ASCs as a viable setting for this care.
4. The OIG’s four red-flag billing measures were specific to OBLs — not ASCs. The report’s scrutiny centered on physicians billing tibial procedures for nearly all patients, performing an above-average number of procedures per patient, regularly billing for more complex procedures per surgical session, and treating a high percentage of early-stage PAD patients. None of these patterns were flagged in the ASC setting.
5. The OIG recommended that CMS increase monitoring of OBL billing for peripheral vascular procedures going forward. As that oversight intensifies, ASCs — which operate under hospital-style accreditation and separate facility fee structures that limit the financial incentive to overperform — may become an increasingly attractive alternative for both physicians and payers looking for a lower-risk setting.
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.
