Comparisons of ASC Procedure Costs and Payments

描述（由申请人提供）：门诊手术中心（ASCs），专门从事不需要过夜住院的手术和/或诊断程序的独立设施，近年来以前所未有的速度增长。据MedPAC称，获得医疗保险认证的asc的数量以每年6.7%的速度增长，从2002年的约3600家增长到2007年的近5000家。伴随这一增长而来的是服务服务支出的大幅增加。医疗保险支付给asc的费用从2002年的19亿美元跃升至2007年的29亿美元。在此期间，每个受益人的ASC支出每年增长超过8%。ASCs的增长可以归因于无数的因素。其中包括麻醉技术的进步和微创手术的发展；医生希望对管理决策有更大的控制权；由于没有紧急病例，日程安排更容易；拥有ASCs作为医生增加收入的途径；以及放宽需求证明法。2008年1月，联邦医疗保险制度对asc的支付系统进行了重大改革，从9个大的支付类别扩大到2400多个类别。令人惊讶的是，这个新的ASC支付计划是在没有关键数据的情况下建立的——可靠和准确的成本估计。因此，由于缺乏准确的成本数据，尚不清楚新的报销制度下的支付是否与提供每项手术服务的成本更加一致。没有经验证据证明在ASC进行门诊手术的费用。考虑到ASCs已成为门诊手术和某些诊断程序的主要提供者，评估成本和支付率至关重要。这个R21应用程序解决了这个重要的知识缺口。首先，我们将使用宾夕法尼亚州2004年至2012年的面板数据来估计ASCs的成本函数，宾夕法尼亚州是唯一一个收取ASCs运营费用的州。其次，我们将使用我们的估计来比较最常见的门诊手术的生产成本和医疗保险报销。由于其探索性，该项目非常适合R21机制。之前没有研究试图估计在ASCs中执行的程序的成本，然后将程序成本与医疗保险报销进行比较。

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 unprecedented rates in recent years. According to MedPAC, the number of Medicare-certified ASCs increased at an annual rate of 6.7%, from about 3,600 in 2002 to nearly 5,000 in 2007. This growth has been accompanied by substantial increases in expenditures on ASC services. Medicare payments to ASCs jumped from $1.9 billion in 2002 to $2.9 billion by 2007. Over this time period, ASC spending per beneficiary rose more than 8% per year. The growth of ASCs can be attributed to a myriad of factors. Among these are technological advances in anesthesia and the development of less invasive procedures; physicians' desire to have greater control over management decisions; ease in scheduling stemming from the absence of emergency cases; ownership of ASCs as an avenue for physicians to augment their income; and relaxation of certificate of need laws. Medicare substantially revamped the payment system for ASCs in January 2008, moving from nine broad payment categories to more than 2400 groups. Surprisingly, this new ASC payment schedule was established without critical data - reliable and accurate estimates of costs. Thus, lacking accurate data on costs, it is unknown whether payments under the new reimbursement system are more in alignment with the costs of producing each surgical service. Empirical evidence documenting the costs of performing outpatient surgery in an ASC is nonexistent. Considering that ASCs have become the dominant provider of outpatient surgical and certain diagnostic procedures, it is critical to evaluate costs and payment rates. This R21 application addresses this significant gap in knowledge. First, we will estimate cost functions for ASCs using panel data spanning the years 2004 thru 2012 from Pennsylvania, the only state that collects operating expenses for ASCs. Second, we will use our estimates to compare production costs and Medicare reimbursements for the most commonly performed outpatient surgical procedures. Because of its exploratory nature, this project is well suited for the R21 mechanism. No prior research has attempted to estimate the costs of procedures performed in ASCs and then compare procedure costs to Medicare reimbursement. PUBLIC HEALTH RELEVANCE: Given that ASCs have become the dominant provider of outpatient surgical and certain diagnostic procedures, it is critical to evaluate costs and payment rates. If our results show that Medicare is overpaying for many outpatient surgical procedures, then substantial savings could be achieved by making further adjustments to the payment rates. Such findings would also provide evidence to support mandating that ASCs submit annual cost reports to CMS.