Physicians blast Medicare plan to curb surgery center procedures

A CMS plan to stop paying for 100 procedures at ambulatory surgery centers could force doctors to upgrade offices or defer to hospitals.

By David Glendinning, AMNews staff. Feb. 14, 2005.

Washington -- Ambulatory surgery centers would be able to start billing Medicare for some additional types of medical procedures under a recent federal proposal, but the update would come at a steep price: Four times as many other procedures would disappear from the covered list.

When the Centers for Medicare & Medicaid Services issued a proposed ASC coverage update in November 2004, some physicians were pleased to see that 25 procedures made the list, including knee arthroscopies and bladder repairs. But CMS removed 100 other Medicare-subsidized treatments, such as prostate biopsies and diagnostic cystoscopies. Doctors have been administering these procedures at the centers for decades.

The move met with strong protest from the ASCs and at least 30 doctor organizations, including the American Medical Association. Deleting so many procedures amounts to the government making arbitrary decisions about the best site of care for a given condition, the groups said.

"The AMA believes the physician, who has firsthand knowledge of the patient's medical history and attendant risk, should have the ability to make an informed decision on a case-by-case basis about the most appropriate surgical environment for Medicare patients," AMA Executive Vice President and CEO Michael D. Maves, MD, wrote in a Jan. 25 letter to CMS. The AMA recommended that the agency drop the deletion proposal altogether.

Forcing doctors to perform the excluded surgeries in their own offices or to refer the patients to hospital outpatient departments could be a serious detriment to patient safety, said Jack Egnatinsky, MD, an anesthesiologist living in St. Croix, Virgin Islands, and the president of the Federated Ambulatory Surgery Assn.