ASC Association Addresses CMS on Low Medicare Payment Rates for 2009

ALEXANDRIA, Va. — The Centers for Medicare and Medicaid Services’ (CMS) move to lower Medicare beneficiary payments to ambulatory surgery centers in 2009 has drawn the ire of the Ambulatory Surgery Center Association.

In a letter addressed to Kerry Weems, acting administrator for CMS, Kathy Bryant, president of the ASC Association, asked CMS to reconsider the outpatient prospective payment system rate (OPPS), which is currently set for 59 percent of hospital outpatient departments (HOPDs), down 4 percent from 2008. At the same time, Bryant expressed concern over the widening gap in payments between ASCs and HOPDs. “Simply put, we do not believe that 59 percent of HOPD rates is either reasonable or fair to ASCs,” said Bryant.

The ASC specialties that would be affected the most from the proposed OPPS rate, according to the ASC Association, are gastroenterology and pain management, which accounted for nearly 52 percent of Medicare ASC reimbursement volume in 2006. Each would see reductions of 6 percent in 2009, but gastroenterology also saw a 5 percent reduction in 2008. “If the ASC-OPPS payment gap continues to grow, we are concerned that certain procedures or classes of surgical services will not be viable in the ASC setting,” said Bryant.

Bryant also suggested to Weems to eliminate the secondary rescaling of ASC relative weights, which “inappropriately reduces payments to ASCs and further exacerbates the growing gap between ASC and HOPD payments...The single most important action CMS can take to reduce this disparity is elimination of secondary rescaling of the relative weights in the ASC payment system.”

Two bills have been introduced in Congress to keep ASC payments rates at 75 percent of HOPDs. H.R. 1823 and S. 2250 would save Medicare “at least 25 cents on every dollar spent relative to HOPD rates,” said Bryant.

To view the entire letter, click HERE.

SOURCE: Ambulatory Surgery Center Association