COVER STORY


Industry experts share tips


the best of what we have


and strategies to make


T


he COVID-19 pandemic wreaked havoc around the world in 2020 and threw all forecasts and projections out the window. As the country continues to respond,


ASCs can keep rolling with the changes, delivering high-quality, lower-cost services to their community, and sharing their story with their patients. Here, ASC professionals, who work with the government in various capacities, came together to offer their perspective on what surgery centers can do this year to stay on the ball.


Medicare Cost Reporting for ASCs Preparing for the future BY I. NAYA KEHAYES


The topic of cost reporting data is frequently central to any discussion about recommended adjustments to ASC Medicare reim-


bursement and the gap in reimburse- ment


between departments (HOPD) and


hospital outpatient ASCs.


Medicare uses hospital cost reporting data to derive HOPD reimbursement rates, and ASCs do not report cost data. The disparity in reimbursement was merely 16 percent in 2003 and is now immense, with HOPD reimburse- ment nearly 100 percent greater than


ASC reimbursement based on the 2020 overall rate differentials. The growth factor in the reim-


bursement gap is concerning and likely not representative of site-of- service variances in cost for delivery of ambulatory surgical services. Cer- tain high-volume ambulatory surgi- cal procedures—such as ophthalmol- ogy surgery, GI endoscopy and pain management procedures—use simi- lar resources regardless of the site of service, yet the reimbursement dif- ferentials remain widespread. There is no data to support the magnitude


14 ASC FOCUS JANUARY 2021 | ascfocus.org


of the increased reimbursement in the HOPD setting. The Medicare Payment Advisory Commission (MedPAC) has repeatedly recommended that the secretary of the US Department of Health & Human Services (HHS) require ASCs to submit cost reporting data, and the commission is expected to make this recommenda- tion again in 2021. MedPAC indicates that it is interested in collecting the cost data from ASCs to assess Medicare’s ASC payments relative to cost. Previous attempts to collect cost data from ASCs have revealed serious issues


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