Ambulatory Surgical Center (ASC) Payment

The Academy believes ambulatory surgical center (ASC) payment should be based on the methodology and payment rates used for hospital-based surgical services. Payments should reflect the actual cost of performing services, rather than broader budgetary factors such as Medicare budget neutrality requirements.

The Academy also supports the use of the most cost-effective setting for surgical services, assuming equal patient outcomes. While the choice of treatment setting should remain at the discretion of the physician and patient, payment structures should not discourage the use of more cost-effective options.

Despite the Centers for Medicare & Medicaid Services' (CMS') efforts to more closely align ASC and hospital outpatient department payment systems, continued discrepancies remain that may discourage physicians from performing procedures in the ASC setting. The Academy has repeatedly urged CMS to address two key issues:

• Permanently adopt the Hospital Market Basket as the ASC update factor because it more accurately reflects costs of the healthcare system.
• Eliminate the secondary weight scalar, which the Academy believes contributes to a widening gap between ASC and hospital payment rates that may not reflect actual cost differences between care settings.

As with the Medicare Physician Fee Schedule, the Academy reviews and comments on each year's proposed ASC payment updates. We work to ensure that CMS decisions are based on accurate data and a thorough understanding of ophthalmic surgical practice.

A large majority of ophthalmic surgical procedures are performed in ASCs, making ASC payment policy a significant issue for ophthalmologists and their patients.

The Centers for Medicare & Medicaid Services sets payment rates differently depending on where a patient receives care. Since 2008, CMS has worked to more closely align the ASC payment system with Medicare's hospital outpatient department (HOPD) payment system. As of 2012, Medicare pays ASCs a prospectively determined rate for covered procedures, with rates updated annually.

Each summer, CMS publishes a proposed rule with ASC rates for the following year — typically around the same time as its proposed Medicare Physician Fee Schedule. Final versions of both schedules are published each fall.