Support builds to protect ambulatory surgery center coverage

The Senate Finance Committee chief says eliminating Medicare pay for some procedures at the facilities could hurt rural patients' access to care.

By David Glendinning — Posted May 2, 2005

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Washington -- A move to preserve the number of procedures covered by Medicare that physicians can perform at ambulatory surgery centers has won some key congressional backing.

Senate Finance Committee Chair Charles Grassley (R, Iowa) expressed concern over the Centers for Medicare & Medicaid Services' proposed plan to remove 100 services, such as prostate biopsies, from the list of covered treatments that can be performed at the centers. Forcing doctors to conduct the procedures in their offices or refer patients to hospital outpatient departments could interfere with a proven care alternative, he wrote in a letter to CMS Administrator Mark McClellan, MD, PhD.

"I am concerned that the recent proposed rule suggests deleting a number of procedures that should not be deleted as long as the procedure can be performed in an ASC setting at the same or greater level of safety as compared to an outpatient setting," Grassley wrote. "Preventing ASCs from performing certain procedures in an ASC setting may affect access to care, especially in rural areas where an ASC is more convenient than an outpatient facility."

The move came as CMS worked to finalize the proposed rule. As of press time, the agency planned to maintain its original timeline by rolling out the final regulation this spring in advance of a July 1 effective date. The rule would allow the surgical centers to charge Medicare for 25 other procedures that are currently not covered -- a change that would be welcome to the facilities and physicians.

Grassley's significant influence in Washington could play a deciding role in the debate, said Kathy Bryant, executive vice president of the Federated Ambulatory Surgery Assn., which represents the centers.

"Chairman Grassley's leadership on this issue could have a profound effect on making it easier for seniors to access safe and affordable surgical services at the nation's ASCs," she said.

The centers have been vocal opponents of the CMS plan since the agency first proposed the rule in November 2004. The group has contested the government's assertions that moving some of the procedures to another setting would save Medicare money. A recent surgery center association-commissioned study by the Moran Co., a health care research and consulting firm in Washington, D.C., projected that the program would spend about $1.6 billion more this year to pay for procedures in the hospital outpatient setting that could be handled by surgery centers.

"ASCs consistently save patients and payers money," said Jack Egnatinsky, MD, an anesthesiologist living in St. Croix, Virgin Islands, and the president of the association. "In a health system plagued by inefficiency, excessive costs and a general lack of responsiveness, ASCs offer a better alternative for surgical care."

Federal officials contend that many of the treatments in question already are being performed in the physician office setting, where costs are often lower.

The American Medical Association counters that physicians might not have the necessary office resources to administer the treatments themselves and should be allowed to determine the best surgical environment for their patients on a case-by-case basis.

The AMA has suggested that CMS drop the proposal altogether and that Congress replace it with an exclusionary list, on which only the procedures that are clinically inappropriate for surgery centers are listed. Medicare currently covers nearly 2,500 types of procedures at more than 4,000 centers throughout the United States.

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