The policy change could save taxpayers and Medicare patients $15 billion over five years, the OIG estimates, but would require legislation letting the Centers for Medicare & Medicaid Services cut the rates for low-risk surgeries “without having to increase other payment rates to make the policy change budget-neutral as required by law.”
“The CMS also said the idea ‘may raise circularity concerns’ because ASC rates are based on a conversion factor from the outpatient prospective payment system for hospitals. Lowering those outpatient rates, that is, could affect the surgical center rates and create a kind of downward spiral.
Lowering those outpatient rates, that is, could affect the surgical center rates and create a kind of downward spiral.”
Lowering those outpatient rates, that is, could affect the surgical center rates and create a kind of downward spiral.”
The CMS said that the Inspector General’s report didn’t offer clinical criteria “to distinguish which patients could be treated in ASCs rather than hospital outpatient settings.”
