The Workers Compensation Research Institute published a study on how Georgia ASCs were paid for procedures after the state changed its medical fee schedule for outpatient services.
In 2014, Georgia set ASC and hospital outpatient facility fee schedule rates at 2.25 times the Medicare Outpatient Prospective Payment System rates applied to hospital outpatient departments.
The report examined payments to Georgia ASCs and HOPDs from when the change took effect May 1, 2014, through March 2017, with a focus on common knee and shoulder surgeries provided under workers' compensation. Findings didn't reflect fee schedule rate changes Georgia made in 2018.
The study found:
- Average facility payments for knee surgeries performed in ASC and HOPD settings didn't change much after the new fee schedule approach went to effect. However, the average doesn't show significant differences across different types of knee surgeries. There was little change for the majority of common knee procedures, but researchers saw a 32 percent increase for other knee surgeries.
- Average ASC facility payments for shoulder surgeries increased in 2014 across most surgery types, which likely reflects the different fee schedule rates for different procedures. After 2014, the average payments for shoulder surgeries in ASCs were higher than the average payments for similar surgeries in hospital outpatient settings.
- Georgia's ASC facility fee schedule rates for typical knee and shoulder arthroscopies were 3.6 to 4.2 times the rates Medicare pays for similar procedures in ASCs. The state's hospital outpatient facility fee schedule rates for common knee and shoulder arthroscopies were 1.8 to 2.4 times the Medicare rates for those procedures in hospital outpatient settings.