Image by Ag Ku from PixabayThe number of ambulatory surgery centers (ASCs) operating in the fee-for-service Medicare landscape is rising. So, too, is the share of traditional Medicare beneficiaries served by ASCs.
That’s according to the Medicare Payment Advisory Commission (MedPAC), which presented on the ASC market as part of its regular health care status report on Jan. 16. The objective of these regular MedPAC presentations is to educate commissioners on the various corners of health care, giving MedPAC the information it needs to make recommendations to Congress.
Overall, there were 6,308 ASCs operating in traditional Medicare during 2023, according to MedPAC. Combined, they served about 3.4 million users while carrying out about 6.4 million surgical procedures.
Fee-for-service Medicare payments to ASCs in 2023 totaled $6.8 billion. Those payments included Medicare program payments and beneficiary cost-sharing liabilities.
What’s especially noteworthy about the size of the ASC Medicare market is not necessarily the fact it’s growing, but rather how fast it’s growing in terms of individuals served.
From 2018 to 2022, the share of fee-for-service Medicare beneficiaries served by ASCs grew by an annual average rate of about 0.9%. From 2022 to 2023, however, the share of beneficiaries served jumped by 5.1%.
In its presentation, MedPAC highlighted how ASCs typically offer patients lower cost sharing, easier scheduling and less time in surgery compared to other alternatives, such as hospital outpatient departments (HOPDs). ASCs also benefit the Medicare program, as ASCs receive lower fee-for-service Medicare payment rates, according to MedPAC.
There’s also better alignment for physicians.
“ASCs offer efficiency to physicians because they can customize their surgical environments and hire specialized staff,” noted the MedPAC presentation.
Another interesting takeaway from MedPAC’s presentation: The number of ASCs varied widely among states in 2023.
In Maryland, there were nearly three dozen ASCs per 100,000 Part B beneficiaries. In contrast, Vermont has fewer than five ASCs per 100,000 Part B beneficiaries; Michigan and Pennsylvania each had under 10 ASCs per 100,000 Part B beneficiaries as well.
Additionally, in 2023, 94% of ASCs were in urban locations, with just 6% in locations considered rural.
“Rural areas often lack surgical specialists and population density to support [the] ASC business model,” MedPAC explained in the presentation.
ASCs were also less likely to serve Medicare beneficiaries who were dually eligible for Medicaid, disabled and over the age of 85, at least compared to HOPDs.
Worth watching: ASCs and Medicare cost data
In its presentation, MedPAC called out ASCs for being the only facilities that do not submit Medicare cost data.
Without such information, the U.S. Centers for Medicare & Medicaid Services (CMS) can’t create payment rates “that accurately reflect ASCs’ relative costs” or “create an ASC-specific market basket that could be used to update ASC payment rates.”
Health care regulators are likewise unable to accurately gauge ASC margins, MedPAC mentioned.
Moving forward, MedPAC recommended that ASCs collect and submit cost data to CMS.
“ASCs are small facilities, but other small facilities … submit cost data,” the presentation explained.
Examples of those small entities include home health agencies and hospices.
