ASCs leaders and physicians are at a pressure point between rising inflation, increased demand for healthcare services and declining reimbursements from Medicare and private payers.
Two ASC leaders—Shakeel Ahmed, MD, CEO of St. Louis-based Atlas Surgical Group and Brian Bizub, CEO of Raleigh (N.C.) Orthopaedic Clinic told Becker's what they want to see CMS take action on for the future of ASC growth and sustainability:
1. Adjusted reimbursement rates. ASCs regularly receive lower reimbursement rates than hospital outpatient departments for the same procedures. CMS' finalized payment rate for ASCs in its 2024 final rule was 3.1%, a decrease from 2023's 3.8%. Both Dr. Ahmed and Mr. Bizub said the reimbursement rate for ASCs should be at least equivalent to that of HOPDs and regularly adjusted for inflation.
"ASCs have lagged behind hospitals in receiving increased payments. That’s long overdue. … It’s crucial for CMS to ensure ASC payments are regularly updated to reflect rising costs," Dr. Ahmed said.
2. Expanded coverage on CMS' covered procedures list. "ASCs have consistently demonstrated their safety and effectiveness over the last 50 years," Dr. Ahmend said. "CMS should support these effective and efficient healthcare entities by expanding the list of procedures reimbursable at ASCs. There is so much more we can do at the surgery centers. So much we can save money on for the system."
3. Decreased administrative burden. Mr. Bizub said that ASCs need "regulatory relief" from CMS, which involves both streamlining existing guidelines and simplifying quality reporting. ASCs have not been spared from healthcare's staffing shortage, and the current administrative burden placed on facilities can take time away from physicians and their patients and increase burnout.
4. Support for innovation. Mr. Bizub also said that CMS should support ASCs in developing new technologies that can enhance patient care. He notes that these innovations can support value-based care initiatives and decrease healthcare costs in the long run.