ADVOCACY SPOTLIGHT


   BY STEVE SELDE


Over the years, ASCA has had many successes in changing federal pol- icy with the support and help of its members.


Looking back over at our successes on the federal level over the last few years, 2016 stands out. That was a meaningful year because we accom- plished two significant priorities, one of which has illuminated a unique issue facing Medicare beneficiaries. In December of 2016, President Obama signed into law the 21st Cen- tury Cures Act. This piece of legisla- tion included dozens of healthcare- related provisions, two of which were directly focused on increasing Medi- care beneficiaries’ access to care in ASCs. The first provision, Section 16003, protected physicians who practice in ASCs from potential pen- alties tied to the Medicare meaningful use program. Prior to this fix, physi- cians who treated patients in an ASC could face cuts in their professional fees. This was because providers were required to adopt and use certi- fied electronic health record technol- ogy (CEHRT) for a fixed percentage of their patients, but no CEHRT was available for the ASC setting. The second provision, Section 4011, directed the secretary of the US Department of Health & Human Services (HHS) to create a public, searchable website that allows Medi- care beneficiaries to compare differ- ences in their out-of-pocket costs and the total expenses for various surger- ies performed in hospital outpatient departments (HOPD) and ASCs.


Today, Medicare beneficiaries and


their families can use the Medicare Procedure Price Lookup website to check the costs between an ASC and HOPD. For example, according to the website, the total cost in the ASC for procedure code 45380, which indi-


38 ASC FOCUS OCTOBER 2020 | ascfocus.org


cates a colonoscopy with biopsy, is about $507, with the beneficiary facing a $101 copay and Medicare reimburs- ing $405. In the HOPD, this same pro- cedure would cost about $1,004, with a beneficiary facing a $200 copay and Medicare reimbursing $803.


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