Ambulatory Surgical Center Changes
Ambulatory surgical centers (ASCs) have become an important element in the health care options available in this country. These facilities are essentially outpatient surgical facilities available to the doctors affiliated with them. Because of the rapid improvement in medical technology, dozens of surgical procedures that would have required an impatient stay a decade ago can now be provided on an outpatient basis, with the patient proceeding home as soon as any medication or anesthesia involved wears off.
These facilities are commonplace – there are over 4,000 of them in all fifty states. They are recognized as legitimate medical facilities, may undergo a certification process, and are eligible for Medicare and Medical insurance payments. Over six million procedures are performed annually at ambulatory surgical centers. Many states require that an ambulatory surgical center be certified in order to administer anesthesia or any form of sedation.
Many facilities make themselves available to physicians on a contract or as-needed basis. Ambulatory centers have become an excellent resource for plastic surgeons because they can bypass the requirements for hospital staff membership and the constantly overcrowded surgical facilities. There are an enormous number of both reconstructive and aesthetic plastic surgery procedures that can be provided in an ambulatory surgical center.
A new ambulatory surgery center payment system went into effect on Jan. 1 as part of the Medicare Modernization Act. They have altered reimbursement levels to reflect costs at standard hospital outpatient rates. They have increase “payment groups” – meaning groups of procedures – from nine to two hundred twenty. While that is a lot of new paperwork for ASC staff, it is a reflection of the expanded use of ASCs and provides a leveling of costs with other medical facilities. It also expands by 750 the number of procedures in an ASC that are eligible for Medicare reimbursement.
The reimbursement changes generally range from 62% to 75% of hospital outpatient day rates. The goal is to level the field with regard to patient costs at an ASC as compared to an acute care hospital. The new payment rules also align ASC services commonly delivered in a doctor’s office with the fee structures there.
There are several rule changes that also deal with quality control, post surgical care, sanitation standards and billing protocol related to the various procedures. The two most common procedures in ASCs are cataract surgery and colonoscopies – which suggests that Medicare patients make frequent use of these convenient facilities.
Currently Medicare has an ASC payment schedule for 2,500 procedures. With the addition of 750 new procedures they have chosen to simply list those procedures which do not qualify for Medicare coverage. Generally, those procedures include medical care which might impose a safety risk for Medicare patients or procedures which might require an overnight hospital stay.
Under the new payment system, Medicare will pay ASCs separately for covered ancillary services if the services are integral to the covered surgical procedure and are provided immediately before, during, or immediately after. Eligible ancillary services include radiology services, separately payable drugs, pass-through payment eligible
devices, corneal tissue acquisition and some tracheal breathing devices.
Generally Medicare will not cover aesthetic plastic surgery but will consider forms of reconstructive surgery. Examples include reconstructive breast surgery following a mastectomy; nasal surgery to correct breathing irregularities; drooping eyelids that impair vision, and so on. Detail on the Medicare definitions of the two types of plastic surgery can be found here.
A good, detailed and consumer oriented explanation of the expansion of Medicare eligible services and the payment rules changes can be found here. The payment rules are the responsibility of medical administrative staff and the Medicare bureaucracy itself. It’s important for Medicare recipients to know, however, that the new rules, categories of service and fee structures are designed to provide fair payment to plastic surgeons and others who use ASCs. Medicare’s hope is to expand the groups of both facilities and physicians who are comfortable with Medicare pay scales.
