Physicians know when ASCs are the best choice

Reversal of a CMS plan to eliminate Medicare reimbursement of ambulatory surgery centers for certain procedures is a victory for organized medicine and for physicians.

Editorial. June 6, 2005.

Physicians are well trained to make sure that they know how to treat a patient's condition. Fortunately, the Centers for Medicare & Medicaid Services now agrees that fine training also gives physicians the insight to know where to treat a patient's condition.

After firm and vocal opposition by the AMA, the Federated Ambulatory Surgery Assn. and at least 30 other medical societies, CMS rescinded plans to delete 100 Medicare-reimbursed procedures from the list of those that could be done at ambulatory surgery centers.

The CMS' proposed ASC coverage update, released in November 2004, added 25 procedures, such as knee arthroscopies and bladder repairs, but took away 100 others, such as prostate biopsies and diagnostic cystoscopies. At the time, CMS' reasoning was that most of the deleted procedures were done primarily in the office setting -- perceived as the least expensive venue.

But CMS has now reversed course, deleting only five procedures and adding 65 more.

What changed its mind? Comments from organized medicine, individual physicians and a powerful senatorial ally. Doctors impressed upon CMS that for many of the procedures in question, ASCs were used only 20% of the time, and that number was not likely to rise quickly. The evidence showed that although physicians tend to be investors in ASCs, they were sending patients to them out of medical necessity, not their own financial interest.