CMS determines reimbursement rates for hospital outpatient departments and ASCs using two different measures of inflation, resulting in significant cost differentials.
For HOPDs, CMS uses the hospital market basket, which measures the cost of medical expenses. For ASCs, CMS uses the Consumer Price Index – Urban, which measures the cost of products such as milk and bread.
Here are five insights on ASCs and HOPDs from a 2018 Regent Surgical Health report.
1. Procedures performed in an ASC setting cost Medicare 53 percent of the amount paid to HOPDs.
2. ASCs perform more than 7 million procedures for Medicare beneficiaries each year.
3. More than $2.3 billion in annual savings is generated when patients undergo certain preventive and surgical procedures at ASCs instead of HOPDs.
4. Hospitals receive $1,745 from Medicare for outpatient cataract surgery procedures; whereas ASCs are paid $976 for the same surgery.
5. "In a fee-for-services world, hospitals received an 81 percent higher reimbursement rate on services performed in the HOPD over those in an ASC," said Regent CEO Chris Bishop. "But those days are going fast. As health systems move toward deriving greater percentages of revenue from value-based care, the potential for higher reimbursement in an HOPD is outweighed by the advantages of leveraging a broader ambulatory platform."