BETHESDA, MD – Ambulatory surgery centers stand to receive less money from Medicare, according to a rule issued in late July by the Centers for Medicare & Medicaid Services.
The Medicare Prescription Drug and Modernization Act of 2003 required CMS to develop a new payment methodology for ASC services, said Jeff Nelligan, director of media affairs for CMS. The agency will pay ASCs at 65 percent of the rate paid to outpatient centers when the rule takes full effect in 2011.
Nelligan said the proposed rule would greatly enlarge the scope of services payable by Medicare in the ASC setting.
“The new system is to be budget neutral,” he said. While aggregate payments in 2008 will remain the same under the new methodology and rates, payments will be reallocated among the services traditionally performed in ASCs, as well as the services newly added to the ASC list, he said.
Some specialists say the cuts are too general to account for varying costs of care among ASCs.
Members of the American College of Gastroenterology say their specialty could be hit harder than others. “GI is an outlier in the cost of providing services because of the technical things we do – the costs are higher than the standard amounts for some specialties,” said David Johnson, MD, president of ACG.
ACG held meetings with other ASC coalitions and members of CMS to discuss the ramifications of the cuts for GI practices, Johnson said. “We saw that we needed a bifurcated fee schedule. CMS seemed to have a pretty good understanding of this, and we were dumbfounded by having (the rule) come out as a one-shoe-fits-all strategy.”
According to estimates, as many as 30 percent of all gastroenterology centers could close within a year of the cuts, Johnson said. As a result, many ASC patients could be sent back to the hospital setting to receive care.
“Here CMS was trying to save money… but now the only alternative for patients will be to go back to the hospital setting, which we know is more expensive, by a huge amount,” said Johnson. “It seems paradoxical.”
ACG’s Michael Safdi, MD, said it doesn’t make sense to move a patient’s care procedure from the outpatient setting to a lower-cost setting without moving the basket of funding.
“(CMS) said we’re not going to save the money from the outpatient and transfer it over to ASCs, we’re going to just cut the ASC,” said Safdi. “It got too complex for them.”
According to Nelligan, CMS developed a system that “attempts to provide a rational relationship between payments for services in ASCs when compared with payments in outpatient departments and those in physician offices.”
“We trust the college will submit its comments formally to CMS before the end of the comment period, so that we can consider them as we develop the final rule,” Nelligan added.
“I think CMS has made their decision – any corrective change would have to come from the legislative side,” Johnson said.
“The intent of the GI societies is to go back and work for a fix for this potentially disastrous event for quality of care for patients.”