Paying for Interventional Pain Services in Ambulatory Settings

摘要

Medicares payment policies should strive to establish rates that approximate theprices that would prevail in the long run in competitive local health care markets to ensure that: (1) beneficiaries have access to high-quality care; and (2) taxpayers and beneficiaries are not unnecessarily burdened through the taxes and the premiums they pay to finance the program. The Congress asked MedPAC to report on the barriers to payment and coverage for interventional pain services furnished in hospital outpatient departments (HOPDs), ambulatory surgery centers (ASCs), and physicians offices. This report gives our response to this question. Medicares policies for paying for interventional pain services are inconsistent across ambulatory care settings. Consequently, the Commission recommends that the Secretary evaluate payments for ambulatory services to ensure that financial incentives do not inappropriately affect decisions regarding where care is provided. The Commission also found that payments for interventional pain services in ASCs probably do not reflect current costs because the rates are based on old charge and cost data. The Commission recommends that the Secretary evaluate payment rates for ASCs using recent charge and cost data from a sample of ASCs and update the list of procedures that are covered when performed in ASCs. With respect to care furnished in physicians offices, the practice expense allocation for interventional pain services performed in physicians offices is lower than the amounts paid for the same services under the HOPD and ASC payment systems. Beginning in January 2002, Medicare will recognize pain management as a specialty group. Consequently, the Commission recommends that the Secretary recalculate the practice expense payments for interventional pain procedures when data become available on the practice expenses of physicians specializing in pain management.