Medicare Reimbursements and A Little Gratitude

It’s been another interesting year for ambulatory surgery centers and Medicare. For starters, the first year of the Centers for Medicare and Medicaid Services’ (CMS) Final Rule four-year transition was initiated with some obvious growing pains. Then at the end of June, a 10.6 percent cut in doctors’ fees was brought into effect, after a filibuster on the Senate floor, only to be eventually worked out by both political parties after leaving physicians in limbo through the Fourth of July holiday.

To make matters worse, in July, CMS updated their payment policies for the 2009 fiscal year. While projecting payments would go up approximately $400 million to participating ASCs, CMS lowered the outpatient prospective payment system rate (OPPS) to 59 percent of hospital outpatient departments (HOPD) — down 4 percent from 2008, a move that drew the attention of the ASC Association.

Kathy Bryant, president of the ASC Association, asked CMS in a letter recently to reconsider their rates, saying it was neither “reasonable nor fair” to ASCs. To put it simply, this gap in payment rates between ASCs and HOPDs will make it difficult for ASC physicians to offer many of the types of fast, convenient surgical care that they currently offer in an outpatient setting. Add in a struggling economy, with fewer patients able to afford these services, you begin to wonder if those physicians will consider leaving Medicare altogether (if they haven’t already), hurting both patient and government at the same time.

There are currently two bills in Congress — H.R. 1823 and S. 2250 — which, at press time, are currently bogged down in committees. Each are pressing CMS to raise OPPS payment rates for ASCs up to 75 percent of HOPDs, a change that would definitely begin to level the playing field for the industry, and allow top-level executives a chance to add some much-needed revenue. In an already important election year, I would certainly suggest you contact your local senator or representative to get the proverbial ball rolling.

At this point, I’m writing this after just returning from the fifth annual today’s surgicenter Conference in Las Vegas, which I thought was a success. Nowhere else were attendees given a chance to hear about the latest legislative, legal and financial issues in our education sessions for ASCs, but for urgent care facilities, even for those of you who are considering crossing over between the two as well. It was certainly an enlightening weekend for myself, not only from said sessions, but from speaking with many of you in person. It really opened up my eyes on how this industry works and where it’s headed in your minds.

I want to personally thank each of you who were able to make it, either as a speaker, sponsor, exhibitor or attendee. We really do appreciate each of you making the trek. Special thanks in particular to our sponsors Physician Planning & Consulting; Reed Smith, LLP; MCM Environmental Technologies Inc.; The Medical Protective Co.; Surgery Partners; Source Medical Solutions Inc.; and VMG Health. It was truly a pleasure to meet all of you and I look forward to working with each of you down the road.

Cheers!

Gabe Molina

Associate Editor