This FlashReport 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.

The study focuses on the trends in ASC facility payments per episode for common knee and shoulder arthroscopies commonly provided to workers with injuries. At the procedure level, it is possible to see how Medicare OPPS fee schedule rates have changed, how the Georgia workers’ compensation fee schedule has incorporated Medicare changes, and how those changes may have affected actual payments. 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 OPPS 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.

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.  

WCRI FlashReport—Payments to Ambulatory Surgery Centers in Georgia: Role of Recent Fee Schedule Changes. William Monnin-Browder, Rebecca Yang, and Bogdan Savych. April 2021. FR-21-01.

Video:

Copyright: WCRI