- On Thursday, Reps. Devin Nunes (R-CA) and John Larson (D-CT) and a bipartisan group of cosponsors introduced legislation in the House aimed at increasing access to ambulatory surgical centers for Medicare beneficiaries.
- The Ambulatory Surgical Center Association praised the move, saying it would close the gap between reimbursement at ASCs and hospital outpatient departments (HOPDs) by using the same inflation measures for both.
- “Without a fix, the disparity between ASC and HOPD payments will continue to widen, potentially reducing access to ASCs and leaving Medicare beneficiaries with only higher options for their care and increased Medicare program expenses,” ASCA CEO William Prentice said in a statement.
Under the Ambulatory Surgical Center Quality and Access Act of 2017, the ASC coverage update would move from the Consumer Price Index for All Urban Consumers to the hospital market basket update, which is more healthcare sensitive.
The bill, similar to legislation advanced last year in the House, also would require CMS to publish side-by-side quality comparisons for ASCs and HOPDs and would add an ambulatory surgery center representative to CMS’ Advisory Panel on Hospital Outpatient Payment.
Another provision would mandate CMS disclosure of which of six exclusion criteria was responsible when a procedure is barred from the ASC approved list.
According to ASCA, Medicare coverage for ASCs is 49% of what HOPDs get paid—down from 86% in 2003. The discrepancy makes it hard for ambulatory surgery centers to stay in business and many sell out to hospitals, only to be converted to HOPDs.
Payment for HOPDs has been an issue in Congress recently. The CMS put forward a final rule in November stating that hospital off-campus facilities will not receive the same rates as hospital-based outpatient facilities. Hospitals that had already begun building HOPDs asked for exemptions for those under construction. The 21st Century Cures Act included some of those exemptions.