New CMS Rules Could Make it Harder for Practices to Sell

 In News

CMS reimbursement rules, along with the moratorium on physician-owned hospitals, has driven the growth in procedures performed outside the hospital setting, such as ambulatory surgery centers (ASC’s). According to the Agency for Healthcare Research and Quality, for example, in 1980, only 16 percent of surgical procedures were performed outside of a hospital. In 2007, this number had grown to 57.7 percent. This circumstance was unquestionably financially devastating to hospitals and in order to assist hospitals, CMS developed reimbursement rules which pay more to hospital based outpatient departments (HOPDs).

Thus, even though non-HOPD procedures are typically more economical, rates from CMS and private payer reimbursements often reflect the opposite. If a hospital campus-based, or free-standing facility can qualify as a “provider-based” hospital outpatient department (HOPD) — or if a physician sells his qualifying practice to a hospital — then Medicare and many private payers reimburse the same services at a higher rate than similar services performed in ASCs (sometimes nearly double). The rationale lies in the need to recompense for the additional expenses hospitals must incur to meet state and federal operational regulations.

Read the full article here:

Recent Posts

Start typing and press Enter to search

Modern HealthcareIBM Watson Health