Becker's ASC Review

89 21. e number of Medicare-certified ASCs increased at an average annual rate of 1.1 percent from 2012 to 2013, with the majority of the new ASCs be- ing for-profit facilities. e growth rate is minimal partly due to the higher Medicare payment rates for ambulatory procedures in hospital outpatient de- partments than in ASCs. From 2012 to 2013, 51 ASC facilities either closed or merged with other centers. 2 22. e Medicare rates are 82 percent higher in hospital outpatient depart- ments than ASCs for 2015. CMS proposes to update OPPS rates by -0.1 per- cent, based on a hospital market basket increase of 2.7 percent with a -0.6 percent adjustment for multi-factor productivity and a -0.2 percent point ad- justment requirement by law for the CY 2016 Hospital Outpatient Prospec- tive Payment System and Ambulatory Surgical Center Payment System. 12 23. e volume of services per FFS beneficiary for ASCs grew by an average annual rate of 0.5 percent in 2013, as opposed to an average annual rate of 2.1 percent from 2008 though 2012. Medicare payments have increased from $3.1 billion to $3.7 billion from 2008 to 2013. Medicare payments per FFS beneficiary increased from $110 million to $112 million from 2012 to 2013, a 2 percent increase. 2 24. e demographics of patients treated in ASCs differ from HOPDs: Medicaid Status Not Medicaid: 86.2 percent ASC, 77 percent HOPD Medicaid: 13.8 percent ASC, 23 percent HOPD Race White: 87.4 percent ASC, 83.6 percent HOPD African American: 6.9 percent ASC, 10.3 percent HOPD Other: 5.7 percent ASC, 6 percent HOPD Age Under 65: 14.7 percent ASC, 22.2 percent HOPD 65 to 84: 78.7 percent ASC, 67.2 percent HOPD 85 or older: 6.6 percent ASC, 10.6 percent HOPD Sex: Female: 57.5 percent ASC, 55.6 percent HOPD Male: 42.5 percent ASC, 44.4 percent HOPD 2 25. Approximately 96 percent of ASCs were for-profit in 2013, showing no change from the number of for-profit ASCs in 2008. 2 26. As a way to enhance patient care provided in ASCs, the Medicare Pay- ment Advisory Commission proposed that CMS implement a value-based purchasing program, rewarding high-performing providers while penalizing low-performing providers no later than 2016. ASCs began submitting data in 2012 under the Quality Reporting Program on four patient safety indicators and one process measure. 14 27. MedPAC recommends CMS incorporates certain patient safety and out- come measures in the ASC VBP program. e value-based program would reward high-performing providers and penalize low-performing providers in an effort to improve the quality of care provided to beneficiaries in ASCs. 2 e recommended safety and outcome measures include: 1. Patient falls in the ASC 2. Wrong side surgery, wrong site surgery, wrong procedure, wrong implant 3. Hospital transfer or admission aer an ASC procedure due to a procedure- related problem 4. Patient burn 5. Surgical site infections 28. CMS finalized the addition of nine spine codes regarding the ASC-pay- able list that were implemented Jan. 1, 2015. e codes include: 22551 Neck spine fuse & remove bel c2 22554 Neck spine fusion 22612 Lumbar spine fusion 63020 Neck spine disc surgery 63030 Low back disc surgery 63042 Laminotomy single lumbar 63045 Removal of spinal lamina 63047 Removal of spinal lamina 63056 Decompress spinal cord CPT codes 22551, 22554, 22612 were moved to codes APC 0425, resulting in a higher reimbursement. 1 29. ASCs utilize various supply chain strategies, with 34 percent of surgery centers using product standardization and an additional 24 percent of centers using GPO evaluation as a supply chain strategy, according to Provista. 13 30. Bundled payments are becoming an increasing trend for payment op- tions in ASCs. Bundled payments are most common among orthopedic procedures and colonoscopy. ey aid in cost management while providing more pricing predictability, said Hoag Orthopedic Institute Administrator Gabrielle White. 31. If only half of the eligible surgical procedures moved to ASCs from hospi- tal outpatient departments, Medicare would save $2.5 billion a year. 1 32. Approximately 35 percent of surgical centers are located in states requir- ing certificate-of-need approval for new ASC developments as listed in Medi- care's Provider of Services data file. 33. CON states are believed to have protection from new competitors because state approval is challenging to obtain for new ASCs. e average lifespan for ASCs in CON states is 4.6 percent longer than ASCs located in non-CON states. 34. Ambulatory surgery centers oen face denied claims, placing additional financial burdens on the centers. Here are the top 15 states with the highest denial rates for surgery centers, according to RemiDATA: info@physiciancontrol.com or call 404.920.4950 www.physiciancontrol.com At IMS affiliated ASCs, physician owners are involved with decision making for the organization, a rare concept in today's ASC environment. IMS specializes in development and management solutions for all types of ASCs. Our emphasis on physician control and our no-nonsense ap approach set us apart from traditional ASC management companies. Our experience allows us to finalize transactions quickly, so you can focus on what matters: your patients. Let us show you how partnering with IMS can enhance your center's success through physician control. Interventional Management Services Less Red Tape. More Time For What Matters.

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