According to Gabel and colleagues, the study of referral patterns in the Pittsburgh and Philadelphia areas revealed that physicians who refer the most patients to physician-owned ASCs disproportionately send privately insured patients there, while sending Medicaid enrollees to hospital outpatient departments. The Pittsburgh and Philadelphia areas were examined because Pennsylvania has both a large number of physician-owned ASCs and a requirement that all ASCs and HOPDs submit discharge abstracts.
However, Mr. Jeffries notes in his response, while the article “attempts to conclude that the safety-net hospitals suffer because physician-owners route low-paying/higher-cost Medicaid patients to hospital outpatient departments (HOPDs) … [the] data clearly demonstrate that 55% of these Medicaid patient referrals go to the physician-owned ASC and 61% of these Medicaid referrals go to a for-profit ASC. Physician-owned and for-profit ASCs are treating a high majority of their Medicaid referrals!”
As a result, he writes, “One might better conclude that physician-owned ASCs have allowed patients, employers, and taxpayers to achieve substantial savings and thus continue the ability of employers and taxpayers to help fund cross-subsidized care at safety-net hospitals. ASCs are strengthening a critical funding source for safety net hospitals — employers — and thus Gabel et al. needs a Time Out because they are operating on the wrong [provider] site!”
Further, Mr. Jeffries’ five-point analysis examines Medicare ASC Growth facility type, patient characteristics, Medicare impact and impact on other states. Read it here.
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.