REGULATORY REVIEW
analysts considered the difference between the average HOPD payment and the average ASC payment to be “savings;” in other words, the Medi- care program “saved” an amount— the payment difference multiplied by the ASC volume—thanks to the procedure being performed in the lower-cost ASC setting. The analysis concludes that, from 2011 to 2018, performance of outpatient surgery procedures in ASCs generated $28.7 billion in savings.
Annual Medicare savings due
to ASCs increased each year, from $3.1 billion in 2011 to $4.2 billion in 2018, according to the KNG analy- sis. This was driven by growth in the total number of ASC procedures as well as the widening gap between HOPD and ASC payment rates. As expected, based on a high volume of
Absent any major policy changes, ASCs are already expected to provide more than $10 billion in annual savings to Medicare by 2027.”
—Alex Taira, ASCA
cataract removals, the surgical cat- egory with the most Medicare sav- ings was eye and ocular adnexa sur- gery. Eye surgeries performed in ASCs save the program well over $1 billion every year and account for approximately 40 percent of over- all ASC savings. Digestive surgeries performed in ASCs also have saved the program more than $500 million every year since 2011.
KNG also projected future sav- ings, or how much ASCs are expected to reduce program spending in future years by performing outpatient sur- geries that would otherwise take place in the higher-cost hospital setting. The future savings estimate was achieved by projecting forward current growth rates of overall outpatient volume and ASC share of every procedure payable by Medicare. KNG found that, even absent any additional policy changes, ASCs are projected to save Medicare $73.4 billion between 2019 and 2028. Savings due to ASCs is projected to increase each year, rising from $4.3 billion in 2019 to $12.2 billion in 2028. According to the analysis, eye surgeries will continue to generate the most savings of any specialty, but by 2025 cardiovascular and nervous sys- tem surgeries will each generate more
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