How Ambulatory Care Centers are Reimbursed

The Affordable Care Act requires the Secretary of Health and Human Services to develop a plan to implement a value-based purchasing (VBP) program for payments under the Medicare for Ambulatory Surgical Center (ASC) program. This is because health services are provided through hospitals or outpatient surgery centers (ASC) in an external location, which makes the service and the outpatient service more efficient and of higher quality. Centers for Ambulatory Surgery (ASC) perform more than 7 million procedures for Medicare beneficiaries who need same-day surgical, diagnostic and preventive procedures. By specializing in specific procedures, ASCs can maximize the efficiency and quality of patient outcomes. The reimbursement policies for hospitals and ASCs are different.

The Hospital Outpatient Prospective Payment System (HOPPS) is used by the Centers for Medicare & Medicaid Services (CMS) to reimburse physicians for surgeries performed in a hospital's outpatient department. On the other hand, Medicare Physician Fee Schedule (MPFS) is used to reimburse surgeries in an ASC. The value-based purchasing program is designed to incentivize ASCs to provide high-quality care at a lower cost. The program will also help to reduce disparities in reimbursement rates between hospitals and ASCs. The VBP program will also help to improve patient outcomes by providing incentives for ASCs to focus on quality improvement initiatives.

This will help to ensure that patients receive the best possible care at an affordable cost.

Dán Luu
Dán Luu

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