I agree with Molly Sandvigs point (Doc-owned hospitals arent just specialty hospitals anymore, Sept. 22 ) about location and emergency treatments but another issue is that of reimbursement or lack thereof.
In 2003interestingly that the data are from 2003Congress and the CMS decided to freeze ambulatory surgery center reimbursement as part of the Deficit Reduction Act. Hospitals are reimbursed in excess of 200% more for outpatient procedures done in their hospital outpatient departments vs. an ASC. A meniscectomy performed in an ASC has a Medicare national reimbursement rate of $770 while the hospital outpatient department rate is $1,833. That is a $1,063 difference in payments. Why is there such a discrepancy?
I presume that this extra funding is a benefit to the hospitals. I would also think the hospitals would be advocating for the physicians to bring their Medicare and Medicaid cases to the hospital vs. the ASC, but they arent. The issue is the commercial insurance. Good grief.
In my opinion, most physicians schedule patients where its convenient for them to perform the procedure and where it makes them more efficient! I would venture a guess that since 2003, the percentages have changed, perhaps not dramatically, but changed as physicians would rather do their cases in one location not two or three. Efficiency for them is most important. Time is money, and last time I looked in the current procedural terminology, or CPT, code book, there was no reimbursement for windshield time.
Stuart KatzExecutive director Tucson (Ariz.) Orthopaedic Surgery Center