GOVERNMENT & MEDICINE

Future is uncertain for surgery center Medicare payment

A reimbursement freeze will be followed by the switch to a still-to-be-determined pay system.

By Markian Hawryluk, AMNews staff. Jan. 12, 2004.

Washington -- After seeing a 60% increase in the volume of Medicare services provided in ambulatory surgery centers from 1998 to 2002, Congress decided it had to do something. Lawmakers just weren't sure what.

The Medicare bill signed into law last month freezes Medicare payment rates for ASCs from late 2005 through 2009 and directs the Dept. of Health and Human Services to implement a new payment system by 2008. But ASCs and the physicians who work in them have few clues to deduce what new payment methodology will replace the current fee-schedule system.

Pay for the centers covers such costs as nursing, recovery care, anesthetics and supplies. Reimbursement for doctors working at ASCs is determined using a different fee schedule.

Congress usually provides at least a general framework when making Medicare payment changes for different types of health practitioners, but this time lawmakers provided little direction. ASC representatives have been supportive of reforming the payment system but are wary of the blank slate Congress provided HHS.

"This could, in the long run, offer an improved mechanism for expanding seniors' access to ASCs," said Kathy Bryant, executive director of the Federated Ambulatory Surgery Assn. "However, whether or not it is a better mechanism depends on the details of its design. We are concerned that the law does not require congressional review of CMS' proposal prior to its implementation."

Meanwhile, this year centers will face a 1% pay reduction, which will drop payment levels to roughly the 2002 rates. After that, the 2005-09 payment freeze will kick in. Bryant said that could lead to access problems.

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