ASCs generally receive lower reimbursement for surgeries than hospital outpatient departments do, according to a study published by the Workers Compensation Research Institute.
Researchers compared the payments ASCs and HOPDs received for knee and shoulder arthroscopies performed on injured workers. The 18 states featured in the study were selected for their geographic diversity, representative system features and representative costs per claim.
WCRI conducted the analysis because evidence about ASC surgeries from Medicare or group health insurers may not apply in workers' compensation settings, according to WCRI Executive Vice President and Counsel Ramona Tanabe.
Here are five takeaways:
1. In 2016, payments for ASC-based knee surgeries were at least 21 percent lower than payments for the same procedures in hospital outpatient settings in 14 states.
2. In three states, payments for knee surgeries were similar between the two settings.
3. Indiana was the outlier; its payments for ASC surgeries were 59 percent higher than payments for HOPD surgeries.
4. Researchers found similar results when comparing shoulder surgeries.
5. Differences between ASC and HOPD payments may be caused by a state's fee schedule regulations, network participation rates or negotiated prices, the study found.
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