Cuts pro­posed for hospi­tal out­pa­tient surgery rates

Modern Healthcare - - NEWS - —Joe Carl­son

HHS’ Of­fice of the In­spec­tor Gen­eral rec­om­mended last week that the CMS seek con­gres­sional ap­proval to pay the same rates for surg­eries in hospi­tal out­pa­tient de­part­ments that Medi­care pays for pro­ce­dures done by free­stand­ing am­bu­la­tory surgery cen­ters. ASCs typ­i­cally are paid 30% to 50% less than hospi­tal out­pa­tientsurgery de­part­ments. The change would only ap­ply to pa­tients at low risk for com­pli­ca­tions.

Ac­cord­ing to federal data, 68% of hospi­tal pa­tients ages 65 and older fall into cat­e­gories of “low risk” or “no risk.”

The rec­om­men­da­tion will face staunch op­po­si­tion from hos­pi­tals. “Medi­care al­ready pays sub­stan­tially less than what it costs to pro­vide out­pa­tient ser­vices in hos­pi­tals, and this would make that much worse,” said Joanna Hi­att Kim, vice pres­i­dent for pay­ment pol­icy at the Amer­i­can Hospi­tal As­so­ci­a­tion.

In 2012, the aver­age op­er­at­ing mar­gin for Medi­care out­pa­tient surgery was a neg­a­tive 11%, ac­cord­ing to a re­port last month from the Medi­care Pay­ment Ad­vi­sory Com­mis­sion, which also rec­om­mends trim­ming rates for hospi­tal out­pa­tient op­er­a­tions.

If the OIG rec­om­men­da­tion is car­ried out, Medi­care could save as much as $15 bil­lion over six years, while ben­e­fi­cia­ries could save $2 bil­lion to $4 bil­lion in co­pay­ments, the of­fice es­ti­mated.

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