The physician head of a trade group for ambulatory surgery centers sent a reminder to members of a Medicare advisory panel last month explaining why federal antikickback and Stark law prohibitions against physician self-referrals were not made applicable to physician-owned ASCs.
The letter from David Shapiro, M.D., president of the American Association of Ambulatory Surgery Centers, was written in the wake of a Jan. 15 MedPAC meeting where several commissioners questioned payments to ASCs with physician ownership and asked about the history behind exemptions and safe harbors, as well as ASCs' impact on rival hospitals.
The discussion dovetailed with an 18-month moratorium Congress imposed on Medicare payments to physicians for procedures in new surgical hospitals in which those physicians have ownership interests. Congress ordered MedPAC to investigate the financial impact of specialty hospitals on competing community hospitals. Shapiro said physician owners of ASCs see further discussion about Medicare payments to ASCs as an extension of a campaign against physician-owned specialty hospitals orchestrated by the hospital lobby. "(We) saw the handwriting on the wall, that this was being portrayed as some kind of evil empire to defraud the government," Shapiro said. "It doesn't take a genius to see that the same arguments brought against surgical hospitals can be brought against ASCs."
Shapiro's letter was addressed to MedPAC Chairman Glenn Hackbarth. His letter pointed out-and offered citations to the Federal Register-that the CMS and Congress exempted ASCs from the Stark laws "because there is no perceived risk of abuse" with ASCs. He also noted a rule published by HHS' inspector general's office specifying safe harbors under the antikickback statute for ASC investments.
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