Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates

摘要

Medicare covers many outpatient surgical procedures commonly performed in both hospital outpatient departments (outpatient departments) and in ambulatory surgical centers (ASCs). Medicare ASC payment rates are frequently lower than outpatient department payment rates. Thus, Medicare generally saves when outpatient surgical procedures that do not pose significant risk to patients are performed in an ASC instead of an outpatient department. Our review quantifies the impact of this payment differential on aggregate Medicare expenditures for outpatient surgical procedures in the ASC setting as compared with outpatient departments. We completed this review in response to a congressional request, which asked us to assess the impact on total Medicare expenditures of providing surgical services in an ASC as opposed to other outpatient settings. Our objectives were to determine how much Medicare (1) has saved as a result of procedures being performed in ASCs instead of outpatient departments and (2) could save if payment rates for the outpatient departments were reduced to the same level as ASC payment rates.