William Prentice, CEO of the Ambulatory Surgical Center Association, recently joined Becker’s to discuss key policy points that the national organization is focused on in the coming years. He identified three main buckets of policy:
Editor’s note: Responses have been lightly edited for clarity and length:
Payment
From 2011 to 2024, the number of Medicare-certified ASCs in the U.S. grew from 1,339 to 2,140, according to VMG Health’s “ASCs in 2024: A Year in Review” report. On Jan. 1, CMS introduced a 2.9% payment increase for ASCs.sparking concern from ASC leaders who believe that the pay increase is too modest to keep up with rising operational costs.
Mr. Prentice said that reimbursement policies are one of the central policy concerns for ASCA in 2025, highlighting that declining reimbursement for ASCs is a missed opportunity for savings in the Medicare program.
William Prentice: In 2019, CMS started measuring inflation in ASCs by using the hospital market basket instead of the Consumer Price Index for All Urban Consumers. This switch was the result of years of ASCA advocacy and a big win for our ASC community. Surgery centers use the same staff, services and supplies as hospital outpatient departments, so it only makes sense to apply the same inflation rate for our yearly updates. However, CMS only made it a pilot program for a five-year trial period, from 2019 to 2023. Due to the impact of the COVID-19 pandemic on volume for part of that period, we were able to convince CMS to extend the trial an additional two years, through 2025. Being updated on the same inflation measures as HOPDs — even though we’re paid different amounts — keeps us on par with HOPDs and creates an incentive for ASCs that accept Medicare to bring in more patients. Going off of the hospital market basket, which we are currently scheduled to do, would be a disincentive to facilities that want additional Medicare patients. It also would add costs to the Medicare program, because those ASC patients would otherwise go to the more expensive hospital setting.
A bigger problem is the fact that the way that our rates are established is through a budget mechanism that needlessly cuts our rates, and we call that the weight scaler. If CMS and the administration would address that, ASCs would be paid better — albeit less than HOPDs — but relatively better. This would incentivize facilities to bring more Medicare patients to the surgery center and generate savings to the Medicare program. These are simple things [the federal government] could do, and they have the authority to do. They don’t need Congress. They could do it themselves. It would reduce costs to the Medicare program, create savings and allow more patients to get care at surgery centers.
Procedures
Mr. Prentice also said that ASCA is paying close attention to the continued migration of procedures to ASCs.
WP: ASCs are allowed to perform a limited number of procedures on Medicare patients. HOPDs are allowed to perform a longer list of procedures on Medicare beneficiaries than surgery centers. We would love to see additional procedures added to our list, because anytime a patient can get that procedure in our setting versus the hospital, it creates savings for the healthcare system at large. There’s a number of cardiac procedures and spine procedures that we’re currently not allowed to perform on Medicare patients. There’s a lot of clinical evidence that shows these procedures can be safely performed on appropriate patients in our setting. We’d like to see the administration give us that authority.
If CMS made the clinical judgment of a physician the most important determinant in where a procedure is performed, that would be a great step forward. Every year, we’re finding there’s more and more procedures that can be performed, on some patients at least, in an outpatient setting. That’s the trend for a lot of healthcare — moving out of the hospital into different sites of care that are more targeted and more efficient. Government regulations can’t keep up with these trends. So to that extent, let the clinical judgment of physicians be the guiding light.
Quality Reporting
Mr. Prentice also said that ASCA is advocating for federal policy makers to make changes to quality reporting requirements for ASCs.
WP: We’ve always been big supporters of the CMS’ quality reporting programs to the extent that they included measures that look at the quality and safety in our facilities. [The quality reporting measures] have helped facilities to compare themselves to other facilities in their market, in their region and around the country, to make sure that they’re high-performing and doing the best possible job. This reporting also provides some evidence to policymakers about the quality of care we’re providing, and we think we have a really good story to tell on that front.
Unfortunately, in recent years, CMS has been adding measures to our program that we don’t think fill those needs and aren’t particularly focused on patient safety. There are a number of measures that were added this past year regarding health equity — which is a really important topic — but which have never been tested in our setting. We believe that [these measures] were a bit of an overreach. The “Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey” measure that just came online this year is overly long, overly expensive and overly burdensome. That could be pared back in a number of ways by, for example, allowing surgery centers to send the survey electronically. That would reduce the costs and make it easier to administer.
We’d love to see some changes to make that program more focused on safety and quality, and easier to comply with for our members. Our fear is that if they keep adding these measures that don’t resonate or make sense, more facilities are going to choose just not to report.
We’d love to see some changes to make that program more focused on safety and quality, and easier for our members to comply with. Our fear is that if they keep adding these measures that don’t resonate or make sense, more facilities are going to choose just not to report.
