Evaluation of ASC Specialization, Costs and Payment Rates

 描述（由申请人提供）：门诊手术中心（ASCs）是一种独立的设施，专门从事不需要过夜的手术和/或诊断程序，近年来发展迅速。ASCs现在是美国门诊手术的主要提供者。在当今的医疗保健市场中存在两种类型的ASC。一种模式专注于单一的产品线，如胃肠病学。另一种类型的ASC是多专业（多产品）模式。典型的多专业ASC类似于医院门诊手术部，因为它提供由不同医生专家执行的各种服务。然而，迄今为止发表的研究未能认识到与专业化相关的潜在差异，因此假设所有ASC都是相似的。经验证据证明，潜在的成本优势的ASC是稀疏的，因为这些设施不需要提交成本或数量的数据CMS。这就解释了为什么医疗保险在2008年实施的新的ASC支付系统在没有关键信息的情况下建立起来-可靠和准确的成本估计。尽管快速扩张的单一专业和多专业ASCs加上新的支付系统，据我们所知，实证研究评估专业化，生产成本和支付率之间的联系是不存在的。我们提出的研究解决了这一重大知识差距。 通过R21探索性拨款的资助，我们证明了估计专注于胃肠病学手术的单一专科ASC的成本函数是可行的。这项拟议的研究扩展了我们以前的工作，将提供一个更全面的画面ASC专业化，成本，效率和足够的ASC支付率之间的关系。具体目标是：1）估计单专科和多专科ASC的成本函数，并使用结果来确定每种组织类型的规模经济; 2）对于特定的诊断和外科手术，我们将比较单专科和多专科ASC的生产成本与保险公司对ASC的支付率; 3）运用随机前沿分析方法，考察单专科供应链与竞争性多专科供应链的相对成本效率。我们建议调查这些问题，使用面板数据的独立ASCs位于宾夕法尼亚州在2004年至2014年的时间段。宾夕法尼亚州是许多ASC的所在地（2012年为281个），也是唯一一个为ASC收取运营费用的州。1996年开始的数据收集程序是标准化的，而且是完善的，这表明报告的可靠性和准确性很高。

 DESCRIPTION (provided by applicant): Ambulatory surgery centers (ASCs), freestanding facilities that specialize in surgical and/or diagnostic procedures that do not require an overnigh stay, have grown at rapidly in recent years. ASCs are now the dominant provider of outpatient surgery in the US. Two types of ASCs exist in today's healthcare market place. One model focuses on a single product line such as gastroenterology. The other type of ASC is the multispecialty (multiproduct) model. The typical multispecialty ASC is akin to a hospital outpatient surgery department in that it offers the gamut of services performed by different physician specialists. Published research to date, however, failed to recognize potential differences linked to specialization and thus assumed all ASCs are alike. Empirical evidence documenting the potential cost advantages of ASCs is sparse because these facilities are not required to submit either cost or volume data to CMS. This explains why Medicare's new payment system for ASCs, implemented in 2008, was established without critical information - reliable and accurate estimates of costs. Despite the rapid expansion of both single specialty and multispecialty ASCs coupled with the new payment system, to our knowledge, empirical studies evaluating linkages between specialization, production costs and payment rates are nonexistent. Our proposed research addresses this significant gap in knowledge. With funding from a R21 exploratory grant we demonstrated that it was feasible to estimate a cost function for single specialty ASCs that focus on gastroenterology procedures. This proposed research extends our prior work and will provide a more comprehensive picture of the relationship between ASC specialization, costs, efficiency and adequacy of ASC payment rates. The specific aims are: 1) To estimate cost functions for single specialty and multispecialty ASCs and use the results to determine economies of scale for each organizational type; 2) For specific diagnostic and surgical procedures we will compare single specialty and multispecialty ASC production costs to insurers' payment rates to ASCs; and 3) To examine relative cost inefficiency of single specialty ASCs and competing multispecialty ASCs using stochastic frontier analysis. We propose to investigate these issues using panel data for freestanding ASCs located in Pennsylvania over the time period 2004-2014. Pennsylvania is home to many ASCs (281 in 2012) and it is the only state that collects operating expenses for ASCs. The data collection procedures, which began in 1996, are standardized and well-established suggesting that reporting reliability and accuracy is high.