The Ambulatory Surgery Center Association has published a full report from KNG Health Consulting that illuminates the immense savings benefits that ambulatory surgery centers provide for the Medicare program. By analyzing Medicare claims data, KNG determined that ASCs currently save Medicare more than $5 billion per year and are projected to save the Medicare program $84.8 billion over the next 10 years.
ASCA previously released top-line results from KNG showing year-over-year historical savings and future projections. The full report delves even deeper into these findings, providing analysis on specific codes, pandemic effects and high-growth outpatient specialties.
“As healthcare costs continue to rise, this report highlights how surgery centers are saving money for the Medicare program and its beneficiaries,” said ASCA Chief Advocacy Officer Kara Newbury. “Patients, providers and policymakers should take note of not only the savings already achieved, but also the increase in projected future savings if care is directed to these safe and cost-effective sites of service for appropriate outpatient procedures.”
Medicare reimburses ASCs at roughly half the rate that it reimburses hospital outpatient departments for the same procedures. This means that every time a procedure for a Medicare beneficiary is performed in an ASC instead of an HOPD, the Medicare program saves money.
KNG’s report also provides novel insights into the usage of ASCs under Medicare Advantage. According to KNG’s analysis, surgery center utilization is almost identical under MA compared to traditional Medicare. While there are slight differences in usage for dual-eligible beneficiaries and certain procedure groups, KNG concludes that the surprising alignment of utilization may highlight opportunities for ASC enhancement under MA.
Methodology
The projection of future ASC savings incorporated assumptions regarding the growth of outpatient surgical volume per enrollee, MA penetration rates and ASC share of outpatient surgeries. The number of beneficiaries covered by traditional Medicare was estimated using county-level data from the U.S. Census Bureau and MA penetration growth rate data from the Centers for Medicare & Medicaid Services. Estimates are calculated for Medicare Fee-for-Service only. Estimates were calibrated and adjusted to align with estimates from the Medicare Trustees.
To read the full report, visit ASCA’s Medicare Savings webpage.
