Cambridge, MA, April 6, 2021 ― A new FlashReport from the Workers Compensation Research Institute (WCRI) examines recent trends in payments to ambulatory surgery centers (ASCs) in Georgia and the role of recent fee schedule changes, including changes to Medicare Hospital Outpatient Prospective Payment System (OPPS) reimbursement rates, which are the basis of the Georgia workers’ compensation outpatient fee schedule.
“While focused on a single state, this analysis has application beyond Georgia, as several states tie reimbursement for facility services conducted in the ASC setting to Medicare rates. Therefore, this is a helpful case study of one state’s experience incorporating Medicare changes into its workers’ compensation fee schedule for ASC facility services,” said Ramona Tanabe, executive vice president and counsel of WCRI.
The study, Payments to Ambulatory Surgery Centers in Georgia: Role of Recent Fee Schedule Changes, focuses on the trends in ASC facility payments per episode for common knee and shoulder arthroscopies. The report found that the trends in facility payments varied across procedures. For example, two of the three common knee surgeries examined have experienced small increases in ASC facility payments per episode since 2014. The third knee surgery has experienced a large decrease since 2014, which followed a rapid increase from 2013 to 2014.
The recent trends in ASC facility payments for these surgeries may reflect several fee schedule changes, including the introduction of comprehensive ambulatory payment classifications and the restructuring of ambulatory payment classifications by the U.S. Centers for Medicare & Medicaid Services, which were largely incorporated by the Georgia workers’ compensation fee schedule. Additionally, Georgia introduced different reimbursement rates for ASCs from those for hospital outpatient departments in 2018, with the ASC rates set at 210 percent of the final OPPS payment rate. Previously, fee schedule rates for both ASCs and hospital outpatient providers were set at 225 percent of OPPS rates. In addition, other factors unrelated to the fee schedule may have also contributed to the recent trends in ASC payments in Georgia.
To learn more about this study or to download a copy, visit https://www.wcrinet.org/reports/wcri-flashreport-payments-to-ambulatory-surgery-centers-in-georgia-role-of-recent-fee-schedule-changes. William Monnin-Browder, Rebecca Yang, and Bogdan Savych are the authors of the study.
The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.