Michael Brady December 05, 2019
The Medicare
Payment Advisory Commission is expected to vote against a pay increase for
ambulatory surgical centers next month because they don't provide cost data.
Medicare payments
to ambulatory surgical centers are probably high enough, MedPAC's staff said at
a meeting on Thursday. They found that beneficiaries have reliable access to
care and that quality is improving. In
addition, ambulatory surgical centers have plenty of access to capital and have
experienced strong growth in Medicare revenue—it grew 7.4% from 2017 to 2018.
Those trends led
several MedPAC members to conclude that there's no need to increase the
conversion factor for ambulatory surgical centers. The conversion factor is a
base payment amount that's used to calculate how much Medicare pays providers.
It's currently scheduled to go up by 2.8% for 2021, but it doesn't appear
necessary based on the findings.
"For the
calendar year 2021, Congress should eliminate the update," said Dan
Zabinski, a senior analyst for MedPAC.
Eliminating the
increase would produce cost savings for Medicare without hurting access to care
or the willingness of ambulatory surgical centers to deliver services to Medicare beneficiaries,
according to MedPAC's staff.
But there's no
way to know for sure how much money ambulatory surgical centers earn from
Medicare services. That's because MedPAC's staff couldn't calculate profit
margins for ambulatory surgical centers because they don't report cost data to
the CMS.
"If you
won't show us your cost reports, we won't show you an update," said David
Grabowski, professor of health care policy at Harvard Medical School.
The commission
can't recommend an update without access to the data they would need to make an
informed decision, said Dr. Francis J. Crosson, MedPAC chairman and founder of
the Permanente Federation.
Ambulatory
surgical centers should be able to submit cost data because other small
providers such as hospices already do it, according to Zabinski.
"We remain
concerned that (ambulatory surgical centers) don't submit cost data, even
though the commission has recommended doing so since 2009," said he said.
HHS Secretary
Alex Azar has the authority to require ambulatory surgical centers to submit
cost data to the CMS, but he hasn't exercised that power yet, Zabinksi said.
Some members of
the commission were skeptical of the value of ambulatory surgical centers in
the absence of data. Ambulatory surgical centers are often physician-owned.
That could give them greater financial incentives to perform additional,
unnecessary surgeries.
"I'm really
struck that we do not know whether (ambulatory surgical centers) have been a
good development or not," said Dana Safran, head of measurement for Haven.
"Paying a lower price for something you don't need isn't a bargain.
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