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Repricing specialty hospital outpatient services using ambulatory surgery center prices.

Healy D, Cromwell J, Thomas FG - Health Care Financ Rev (2007-2008 Winter)

Bottom Line: Medicare outpatient claims in 43 orthopedic and 12 surgical specialty hospitals in 2004 were repriced using ASC pricing software.Payments for the same surgical procedure were 43 and 64 percent higher in specialty surgical and orthopedic outpatient departments, respectively, compared with simulated ASC payments.Non-ASC-eligible outpatient services were 18-35 percent of all Medicare outpatient payments varying by type of specialty hospital.

View Article: PubMed Central - PubMed

Affiliation: Avila University, USA.

ABSTRACT
This article explores whether Medicare pays more for the same outpatient services provided in an acute specialty hospital than in an ambulatory surgery center (ASC). How financially dependent a specialty hospital is on ASC-eligible services is also investigated. Medicare outpatient claims in 43 orthopedic and 12 surgical specialty hospitals in 2004 were repriced using ASC pricing software. Payments for the same surgical procedure were 43 and 64 percent higher in specialty surgical and orthopedic outpatient departments, respectively, compared with simulated ASC payments. Non-ASC-eligible outpatient services were 18-35 percent of all Medicare outpatient payments varying by type of specialty hospital.

Show MeSH
Orthopedic Specialty Hospitals: Outpatient Share of Medicare Total Revenues: 2004
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC4195025&req=5

f1-hcfr-29-2-081: Orthopedic Specialty Hospitals: Outpatient Share of Medicare Total Revenues: 2004

Mentions: Figures 1 and 2 show the distribution of Medicare outpatient payment shares for 43 orthopedic and 12 surgical specialty hospitals respectively. Orthopedic specialty hospital Medicare outpatient revenue shares range from a low of 9 percent to a high of 85 percent (mean share = 42 percent). Some of the variation can be explained by service mix. Some orthopedic hospitals specialize in hip and knee surgery while others specialize in back surgery that requires less inpatient care. Consequently, care must be taken when generalizing the revenue impacts from OPPS-ASC payment differences to particular orthopedic specialty hospitals.


Repricing specialty hospital outpatient services using ambulatory surgery center prices.

Healy D, Cromwell J, Thomas FG - Health Care Financ Rev (2007-2008 Winter)

Orthopedic Specialty Hospitals: Outpatient Share of Medicare Total Revenues: 2004
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195025&req=5

f1-hcfr-29-2-081: Orthopedic Specialty Hospitals: Outpatient Share of Medicare Total Revenues: 2004
Mentions: Figures 1 and 2 show the distribution of Medicare outpatient payment shares for 43 orthopedic and 12 surgical specialty hospitals respectively. Orthopedic specialty hospital Medicare outpatient revenue shares range from a low of 9 percent to a high of 85 percent (mean share = 42 percent). Some of the variation can be explained by service mix. Some orthopedic hospitals specialize in hip and knee surgery while others specialize in back surgery that requires less inpatient care. Consequently, care must be taken when generalizing the revenue impacts from OPPS-ASC payment differences to particular orthopedic specialty hospitals.

Bottom Line: Medicare outpatient claims in 43 orthopedic and 12 surgical specialty hospitals in 2004 were repriced using ASC pricing software.Payments for the same surgical procedure were 43 and 64 percent higher in specialty surgical and orthopedic outpatient departments, respectively, compared with simulated ASC payments.Non-ASC-eligible outpatient services were 18-35 percent of all Medicare outpatient payments varying by type of specialty hospital.

View Article: PubMed Central - PubMed

Affiliation: Avila University, USA.

ABSTRACT
This article explores whether Medicare pays more for the same outpatient services provided in an acute specialty hospital than in an ambulatory surgery center (ASC). How financially dependent a specialty hospital is on ASC-eligible services is also investigated. Medicare outpatient claims in 43 orthopedic and 12 surgical specialty hospitals in 2004 were repriced using ASC pricing software. Payments for the same surgical procedure were 43 and 64 percent higher in specialty surgical and orthopedic outpatient departments, respectively, compared with simulated ASC payments. Non-ASC-eligible outpatient services were 18-35 percent of all Medicare outpatient payments varying by type of specialty hospital.

Show MeSH