ASCs and Healthcare Reform

How closely have you been following the healthcare reform legislation? It’s challenging, isn’t it? You’re not alone; I recently spoke with Kathy Bryant, president of the ASC Association, and even she finds the task to be daunting. Although the world could be a very different place when this issue actually hits your mailbox, as of press time in mid-August, the House disbanded for its summer recess without voting on a healthcare system reform bill. I believe at this very moment, there are three or four versions of the legislation on the table and it makes me laugh — even the process to address our convoluted system is complicated! With Republicans vowing to dismantle the legislation and even conservative Democrats unhappy with the bill, a modified version of America’s Affordable Health Choices Act now lingers; its final disposition is anyone’s guess.

So where do ambulatory surgery centers (ASCs) belong in the healthcare reform discussion? Bryant believes that everything lawmakers need to know is contained in the Ambulatory Surgical Center Access Act of 2009. The gist of the act is what you already know by heart — that ASCs provide patients with a high-quality, convenient and less expensive option for their outpatient surgery. And when Medicare beneficiaries are able to select ASCs for their surgeries, both the beneficiary and the Medicare program save a significant amount of money. ASCs remain a cost-effective mode of healthcare delivery for patients, but it’s critical that ASCs have a reasonable payment system in order for them to continue to provide their surgical services.

At one time in the not-so-distant past, ASCs were paid an average of 86.5 percent of hospital outpatient departments (HOPDs), but the ravages of a multiple-year payment freeze and additional cuts have decimated ASC payments. How could anyone think that 59 percent of HOPD payment for the identical surgeries could be acceptable? The Ambulatory Surgical Center Access Act of 2009, among other things, would freeze payment at this 59 percent while requiring MedPAC to conduct a study to evaluate how to encourage more clinically appropriate outpatient surgical services to be provided at the most cost-effective site of care. The bill also clarifies that ASCs may provide surgery to patients on the same day it is scheduled.

It will be a very interesting autumn, as the ASC community continues to lobby on its agenda, and hopefully the Act will gain more ground this year than it has in previous Congressional sessions. In the meantime, in this issue we take a look at the ASC reimbursement picture from several perspectives, beginning on page 14, to bring you up to speed on where we stand and what 2010 could bring.