New MedPAC Reports Analyzes High-Volume Medicare Procedures

JOHNSON CITY, Tenn. – The American Association of Ambulatory Surgery Centers (AAASC) reports that the Medicare Payment Advisory Commission (MedPAC) issued last week two reports, both assembled by RAND, which are of great potential interest to the ambulatory surgery center (ASC) community. The studies compare patient characteristics for several procedures across various ambulatory settings, cataract surgery, colonoscopy, and MRI of head, neck and brain in hospitals and ASCs.

The first report summarizes a review of the clinical literature for the three selected procedures.  The second report describes the results of an examination of the clinical literature by an expert panel, which included representatives from the relevant medical communities, and which examined differences in outcomes, patient characteristics and procedure characteristics across multiple ambulatory settings.

With respect to cataract surgery, RAND found the following:

-- 52 percent of Medicare cataract procedures were performed in an ASC setting;

-- Hospitals generally treat a more acute patient, who is expected to consume more medical resources, although the difference in patient type between hospitals and ASCs was small; 

--Hospitals showed consistently worse outcomes than ASCs across 17 measures identified by the expert panel, including stroke, dislocated ocular lens, vitreous loss and iris prolapse.

With respect to colonoscopy, RAND concluded:

-- 70 percent of colonoscopies were performed in a hospital outpatient department (HOPD), 26 percent in an ASC, and 4 percent in physician offices. Gastroenterologists performed a higher percentage of colonoscopies in ASCs than in HOPDs  or offices.

-- Hospitals generally treated patients with slightly higher acuity scores than ASCs or offices.

-- Adverse outcomes following colonoscopies occurred at very low rates in all three settings.

The report will be reviewed and cited as policymakers address a plethora of issues of concern to the ASC community, from the rebasing of ASC facility fees to the potential elimination of the ASC procedures list to the possible application of some further restrictions on physician ownership of and referral of their patients to ASCs.  For example, Rand determined that the cataract patient treated in the hospital patient is 7 percent more acute than the patient treated in the ASC. However, Medicare reimbursement to a hospital for the most commonly billed cataract procedure, CPT 66984, will be more than 36 percent higher than the ASC payment in 2005. The unadjusted national fee for CPT 66984 to an ASC will be $973 in 2005, while the corresponding hospital payment will be $1,329. The AAASC says the RAND report raises as many questions as it answers because it does not address how to translate this higher acuity into a quantification of the additional resources consumed in providing this care or into an appropriate reimbursement differential between the two settings.  

With respect to outcomes, RAND corroborated the long-held belief among ASC proponents that the specialization common to ASCs enhances quality and improves outcomes.

Both reports are available on MedPAC’s web page at www.medpac.gov

Source: AAASC