Payments to Ambulatory Surgery Centers in Georgia

By Bogdan Savych

August 16, 2018 Related Topics: Ambulatory Surgery Centers, Fee Schedules

This study explores how facility payments for surgeries conducted in ambulatory surgery centers (ASCs) in Georgia changed after the 2014 changes in the medical fee schedule for outpatient services.

Effective May 1, 2014, Georgia changed its ASC and hospital outpatient fee schedule to follow Medicare’s Hospital Outpatient Prospective Payment System (OPPS) ambulatory payment classification approach. The new fee schedule method set ASC and hospital outpatient facility fee schedule rates at 2.25 times the Medicare OPPS rates that applied to hospital outpatient departments. While prior studies show that average facility payments in Georgia increased faster than in other states after 2014, little was known about the main factors behind these trends. Although Georgia made additional fee schedule rate changes in 2018, those are not reflected in this analysis.

The report examines payments to ASCs and hospital outpatient departments for surgical episodes in Georgia through March 2017. The analysis focuses on the most common surgeries provided to injured workers for treating knee and shoulder conditions in workers’ compensation.

Payments to Ambulatory Surgery Centers in Georgia. Bogdan Savych. August 2018. WC-18-23.

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Research Questions:

  • How did facility payments for knee surgeries performed in ASC and hospital outpatient settings in Georgia change after the 2014 fee schedule changes?
  • How did facility payments for shoulder surgeries performed in ASC and hospital outpatient settings in Georgia change after the 2014 fee schedule changes?
  • How do Georgia’s ASC and hospital outpatient facility fee schedule rates for common knee and shoulder arthroscopies compare with the rates that Medicare pays for similar services performed in ASC and hospital outpatient settings?

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