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ASCs look to benefit from Medicare rule changes
Centers may receive ‘substantial’ increases in payments for some retinal procedures, a health care consultant said.
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Recent changes to Medicare payments could offer unexpected growth opportunities for ASCs, according to one health care consultant.
ASC owners need to look at hard data before adding new procedures or inviting other surgeons to operate at their facility, said Bruce Maller, president of BSM Consulting in Nevada.
“For many ophthalmologists, ownership of an interest in an ambulatory surgical center is a significant part of their business plan,” Mr. Maller said, noting the specialty’s entrepreneurial quality.
“This is a great business,” he said. “And as long as there is a significant differential between what a hospital outpatient department is being paid for cataract surgery vs. an ASC, there’s still going to be a tremendous incentive for cases to be driven to the ASC. This is a low-cost, high-quality, efficient provider of surgical services.”
The payment changes, recently adopted by the Centers for Medicare and Medicaid Services, add several ophthalmic surgical procedures to the list of those covered by Medicare, Mr. Maller said.
“The good news … is that there are some additional ophthalmic procedures that will be added to the covered service list,” he said. “The good news is also that many retinal surgical procedures are looking at substantial increases in reimbursement compared to, say, the 2007 national fees.”
However, he echoed the concerns of some ophthalmology advocacy groups, which voiced concerns over CMS’ proposal that Medicare ASC payments would equal 65% of hospital outpatient department rates in 2008. These groups have called for a 75% conversion rate.
Adding retinal procedures
Using a hypothetical case study of an ASC to illustrate the impact of Medicare rule changes, Mr. Maller showed that, even accounting for increased supply costs, the addition of retinal procedures increased the facility’s net income.
However, he advised ASC owners and administrators to address a few key issues before adding retinal procedures to the list of services they offer.
“In a perfect world, if you had additional cataract surgeries that could be done at the facility, they would be my first choice, just from a business standpoint. But sometimes there are extenuating circumstances,” Mr. Maller said. “You might have retina specialists in the practice who have been clamoring to work at the facility. In years past, you told them, ‘No, it does not make economic sense to perform retina procedures in the ASC.’ Given the changes in reimbursement for retina procedures, it may now make sense to make the time available for them.”
ASC owners also need to address increased capital and operating costs, case volume and surgeon training and experience, he said.
“Of course, the speed and efficiency of the surgeon become key factors because these cases tend to take longer, even a less complex retinal detachment or even a vitrectomy,” Mr. Maller said. “They’re going to take longer than certainly a cataract surgery would, and they would consume more resources. So if the surgeon has experience working in an ASC environment and there are staff in the facility that have experience and are trained, it may be something for you to consider.”
For more information:
- Bruce Maller is president of BSM Consulting. He can be reached at 936 Southwood Blvd., Suite 102, Incline Village, NV 89451; 775-832-0600; fax: 775-832-0664; e-mail: bmaller@bsmconsulting.com. Mr. Maller has a consulting agreement with Allergan Inc.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.