ALEXANDRIA, Va., Nov. 22 /PRNewswire/ -- Proposed changes in Medicare announced today could mean that more patients will have access to safe and affordable procedures provided at Ambulatory Surgery Centers (ASCs). According to the Federated Ambulatory Surgery Association (FASA), the nation’s largest association of ASCs, the Centers for Medicare and Medicaid Services is proposing to add 25 procedures to the ASC payment list, enhancing options seniors have when it comes to surgery providers. However, as FASA’s Executive Vice President Kathy Bryant said, “FASA’s enthusiasm for a timely updating of the ASC list dissipated quickly when we realized that more codes were being deleted than were being added, resulting in Medicare beneficiaries having less access to ASCs.”
Included in the 25 procedures proposed for addition in the proposed rule made available for public inspection today were knee arthroscopy (29873) and repair bladder defect (57288), both outpatient surgeries that are performed in ASCs safely and efficiently for patients with other types of insurance and have been for some time. Just 30 years ago, nearly all surgery was lengthy and complex and took place in hospitals. Today, seventy percent of all surgeries in America are outpatient, and one out of every five of these is performed at an ASC. Giving Medicare beneficiaries more access to ASC services helps level the playing field between those on government programs and those in other insurance plans.
“Updating Medicare’s ASC list on a timely basis helps to give Medicare beneficiaries the same opportunities patients with other plans have for safe, efficient and cost-effective outpatient surgery,” said Jack Egnatinsky, MD, FASA’s president. “ASCs save patients on out-of-pocket expenses while offering high quality service -- a critical factor when considering that the second leading cause of personal bankruptcy is medical bills.”
Making the affordable and safe care found at ASCs more available to America’s seniors is a smart move, Egnatinsky added, particularly as the country’s population ages. Study after study shows that the number of outpatient surgeries is projected to increase substantially as Baby Boomers age. Expanding the list of services Medicare will cover in ASCs is essential in enabling the country to meet growing surgical demand.
Even if the proposed additions are accepted, however, FASA said that Medicare beneficiaries still will not have access to several procedures ASCs perform routinely on patients covered by other plans, such as removal of lesions and detached retina.
Based on a complete review of the proposed rule change, FASA will be submitting comments to CMS that applaud the additions but also encourage regulators to make the changes that are still necessary before the rule is finalized. Decreasing beneficiaries’ access is not appropriate.
“Adding procedures to the ASC list is good news for both Medicare beneficiaries and the Medicare program,” said Bryant. “ASCs save both Medicare and patients money through lower premiums and co-payments. There are many procedures being performed in ASCs that meet Medicare’s requirements, but are just not on the Medicare list -- it’s time to include them.”
The good news is tempered, however, by the fact that Congress placed a five-year freeze on Medicare payments to ASCs, Bryant said. “If Congress does not act, even with the enhanced ASC list, the extended freeze could seriously compromise an ASC’s ability to offer the full range of high quality surgical services to Medicare patients.”
FASA’s comments will also discuss the procedures CMS is proposing to remove from the list and will object to deleting any that meet Medicare criteria. “The truth is,” Bryant added, “that the list-making process is problematic. As long as a list exists, CMS will be unable to keep pace with the rapid changes in health care delivery.” FASA supports changes that the Medicare Payment Advisory Committee (MedPAC) has proposed to the process which will go a long way toward improving beneficiaries’ access to health care.
If approved, the new rule is expected to go into effect July 1, 2005. About the Medicare ASC List
The issuance of this proposed rule is the first step in updating the ASC list. CMS is required by law to update the list of approved procedures every two years, with the last update having become effective in July 2003. Prior to that, the list had no new procedures added since 1995. Medicare rules establish requirements that procedures must meet to be added to the ASC list. Procedures must have a duration of less than or equal to 90 minutes and a recovery time of less than four hours. Currently there are 2,467 procedures on the ASC list. When procedures on the ASC list are performed in an ASC, Medicare pays the ASC a “facility fee” to cover the costs of the operating room, staff and supplies. National payment rates range from $333 to $1,339. The physician performing the surgery and the anesthesiologist also receive Medicare reimbursement.
The Federated Ambulatory Surgery Association (FASA) is a national, nonprofit association that represents the interests of those who operate and seek the services of ambulatory surgery centers (ASCs) throughout the nation. Visit FASA online at http://www.fasa.org/.
CONTACT: Allison May Rosen of Ignition Strategic Communications, +1-202-339-0111, or arosen@ignitioncom.com, for the Federated Ambulatory Surgery Association.
Federated Ambulatory Surgery Association
CONTACT: Allison May Rosen of Ignition Strategic Communications,+1-202-339-0111, or arosen@ignitioncom.com, for the Federated AmbulatorySurgery Association
Web site: http://www.fasa.org/