Orthopedic surgery payments lower at ASCs than HOPDs

Written by Shayna Korol | November 21, 2018 | Print  |

In 2016, payments for knee surgeries performed at ambulatory surgery centers were at least 21 percent lower than payments for hospital outpatient surgeries in 14 states, according to a FlashReport from the Workers Compensation Research Institute.

The study included 18 states. Authors examined payments to ASC and hospital outpatient departments, focusing on knee and shoulder arthroscopies, the most common procedures performed in outpatient settings. The findings include information on all payments within a surgical episode, excluding payments to surgeons or other healthcare providers.

Here are three things to know:

1. Payment rates between ASCs and HOPDs were similar in three states, and ASC payments were 59 percent higher in Indiana compared to payments for hospital outpatient surgeries. Researchers found comparable results for shoulder surgeries. 

2. Changes in states' fee schedules impacted ASC payment trends for surgeries in several states. For example, average payments for knee surgeries in North Carolina decreased 55 percent between 2012 and 2016. In New York, average payments for knee surgeries increased 50 percent between 2015 and 2016. 

3. Study authors identified states' fee schedule regulations, network participation rates and negotiated price as factors contributing to differences in ASC and hospital outpatient surgery payments. 

"This analysis is important since evidence about ASC surgeries from other payors (Medicare or group health insurance) may not apply in workers' compensation settings," said Ramona Tanabe, WCRI’s executive vice president and counsel.

More articles on practice management:
Pennsylvania health system expands orthopedic services, opens new location: 3 details
Central Indiana Orthopedics breaks ground on new location: 4 notes
Key thoughts on spine surgery reimbursement and the value equation: Q&A with Dr. Jeffrey Cantor

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