ASCs throughout the U.S. face skyrocketing operational costs alongside declining reimbursements from payers.
Here are five things to know about ASCs and declining reimbursements:
1. Declining reimbursements could start impacting smaller practices more. With CMS' 3.1% finalized payment rate for ASCs in 2024, small practices with more Medicare patients and lacking the leveraging power of large networks could bear the brunt of the incongruency,
"I worry that eventually small ASCs in small towns or markets are not going to be able to make it because they can't afford it," April Aud, RN, BSN and administrator of Black River Ambulatory Center in Poplar Bluff, Mo., told Becker's. Especially because these smaller ASCs often have a lot of Medicare patients, the reimbursement there is not sufficient and there's a limited number of commercial patients. I worry that a lot of small ASCs that serve communities that really need the ASCs in the area are not going to be able to survive."
2. Reimbursements trail the migration of procedures to ASCs. "Insurance companies have been trying to push certain procedures toward the ASC, which is great, but will reimbursement catch up?" Ms. Aud said. "ASCs are such a benefit to the medical community, but getting Medicare, Medicaid and commercial payers to catch up is the hardest part."
3. Market competition is another driver of decreasing reimbursements. Hospitals own about 2% of ASCs around the country, according to a report from Complex Claims Revenue Solutions. While this percentage seems small, these ASCs may have different reimbursement structures and more leveraging power to negotiate better rates with payers.
4. Higher acuity procedures often come with more paperwork. As increasingly higher acuity procedures are performed in ASCs, payers willing to cover these procedures in the ASC setting may also have stricter documentation requirements for prior authorization and compliance.
5. Value-based care models are also shifting reimbursement rates. According to a May 13 report in Cardiovascular Business, Medicare payments could be 100% tied to value-based models by 2030. This shift away from fee-for-service will recalibrate reimbursements to reflect the quality and efficiency of care delivered.