NEWS YOU CAN USE: GAO Recommends This New ASC Payment System.

Ambulatory surgical centers (ASCs) could soon have a new payment system to contend with, thanks to a new report from the Government Accountability Office (GAO) (GAO-07-86).

Congress asked the GAO to study the differences between payments in the hospital outpatient department and the ASC setting. The GAO found that the outpatient payments accurately reflected the costs of the same procedures in ASCs.

The GAO’s analysis of the ASC-to-APC and OPPS-to-APC cost ratios showed that 45 percent of all procedures in the analysis fell within a 0.10-point range of the ASC-to-APC median cost ratio, and 33 percent of procedures fell within a 0.10-point range of the OPPS-to-APC median cost ratio, the report says.

The analysis also identified differences in the cost of procedures in the two settings. The median cost ratio among all ASC procedures was 0.39, and when weighted by Medicare claims volume was 0.84, while the median cost ratio for OPPS procedures was 1.04, the report shows. Thus, the cost of performing surgeries in the ASC setting is “substantially lower” than in the outpatient departments, the GAO found. The GAO recommends that Medicare pay for ASC procedures based on the hospital outpatient prospective payment system (HOPPS). The Centers for Medicare & Medicaid Services said this recommendation was in line with its own proposals from August 2006.


- Published on 2007-01-14