Many ASCs are being forced to shift the way they operate as practice costs soar and payer reimbursement rates sink.
While the Medicare payment rate increase of 3.1% for ASCs was finalized for 2024, many leaders feel it's not enough to offset the rising cost of practice.
"As the acuity level of procedures in the ASC setting continues to grow, so does the cost associated with doing these procedures," Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker's. "Reimbursement from third-party insurance payers has not followed suit."
The dynamic has a "direct financial impact," Mr. Feldman told Becker's, forcing ASCs to be "very discretionary" about the types of cases they perform.
"Previously, it was all about volume. Now, it’s more about doing the right type of cases," he said. "As the acuity level of cases migrates from hospitals to ASCs, the cost to perform these cases increases, but reimbursement remains lower, which will become a significant obstacle."
For his team, he's found that there are certain cases the ASC can't perform because it's not financially feasible.
"For example, we had a case last week by one of our orthopedic surgeons. The total reimbursement was $3,200, but the case cost us almost $4,100 to perform when factoring in the salaries of the staff and the implants," he said. "Many contracts don’t include implants, especially for joint replacements, and these implants can cost thousands of dollars."
It has also become more difficult as payers have changed their reimbursements structures, he added. Medicare used to pay a percentage above the costs for lenses in ophthalmology, for example, but now provides no payment at all.
There's also the disparity between reimbursements for hospital outpatient departments compared to ASCs.
"Insurance companies have been trying to push certain procedures towards the ASC, which is great, but will reimbursement catch up?" April Aud, RN, BSN, the administrator of Black River Ambulatory Surgery Center in Poplar Bluff, Mo., told Becker's. "ASCs are such a benefit to the medical community, but getting Medicare, Medicaid and commercial payers to catch up is the hardest part."