The Ambulatory Surgical Center Quality and Access Act of 2013 (H.R. 2500/S. 1137) requires the Centers for Medicare and Medicaid Services to use the hospital marketbasket to determine payments for services performed in ambulatory surgery centers.
The open house is scheduled for Sept. 18.
Surgery Center Administrator Marietha Silvers said the biggest concern for them is ASCs do not have a marketbasket update and the default update mechanism is the Consumer Price Index for All Urban Consumers, which does not appropriately measure the costs of an ASC.
“Our payment levels are not set up the same as hospital payment increases are done through the hospital marketbasket,” she said. “Ours is in the Consumer Price Index, which makes no sense for health care.
“Basically, our raises are based on the price of milk and eggs,” she said.
Silvers said hospital payments are based on the cost of medical equipment and supplies. ASCs are lumped in with milk and eggs, which results in drastically lower reimbursements.
“There are benefits because we want to be a cost-effective industry. We do not want to be equal to hospitals because then we wouldn’t be saving the government money, but we still have to survive,” she said.
Silvers said hospitals are important to the economic and physical well-being of communities and ASCs enjoy symbiotic relationships with the larger medical institutions. Having hospitals nearby is an asset to ASCs.
Most ASCs are small businesses like other businesses across the country. Many of them are mom and pop-type operations. Local physicians own the Surgery Center of Cleveland.
“If you get rid of the competition and small businesses because we can’t compete, then the cost of health care is just going to go up,’ she said.
Among other things, the bill would require development of a value-based purchasing program for surgery centers by Jan. 1, 2015. The established system would assign a score based on its performance on the quality measurements. As an example, facilities would not be required to report on measures inappropriate for a particular facility such as shaving the surgical site in ASCs that perform ophthalmic procedures.
Silvers said the local surgery center has less than 20 full-time employees. Most are part time and PRN, who work on an as-needed basis. Even so, Registered Nurses staff is required.
“That’s truly a small business, but we are still required to have all professionals employed here who have degrees, licenses and the required education and a full-time anesthesiologist,” Silvers said. “We run a full gamut of ambulatory surgery center.”
The center is required to have all of the equipment to sustain a patient, but because it is a small business, it lacks the buying power of a larger company.
“It would cost us more for the exact same piece of equipment, but our reimbursement is almost 45 percent less,” she said.
The surgery center serves about 4,500 patients each year and has a 98-plus percent satisfaction rate.
“Most of our business is word-of-mouth, the patients want to come back,” she said.