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Medicare Cost Savings Tied to Ambulatory Surgery Centers
Produced with cost savings analysis from
Acknowledgements
Dr. Brent Fulton, Assistant Adjunct Professor and Research Economist, and Dr. Sue Kim, Research Scientist, both from the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, School of Public Health, University of California-Berkeley, conducted the cost savings analysis presented in this report.
Table of ContentsEXECUTIVE SUMMARY
I. AN INTRODUCTION TO AMBULATORY SURGERY CENTERS
II. ASCS: SAVING THE SYSTEM
III. COST SAVINGS ANALYSIS
A. DATA AND METHODOLOGY
B. PAST SAVINGS
C. FUTURE SAVINGS
D. CONCLUSIONS
IV. POLICY IMPLICATIONS AND CONSIDERATIONS
A. AVOIDING ASC TO HOPD CONVERSIONS
B. ASCS AS PART OF BROADER COST-SAVINGS EFFORTS
APPENDIX: METHODOLOGY AND CHART OF INDIVIDUAL
PROCEDURE SAVINGS
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EXECUTIVE SUMMARY
Even in today’s divisive political environment, there’s at least one important area of consensus among policymakers: the threat posed by rising health care costs to both our national economy and the federal and state governments’ balance sheets. This concern is particularly acute in the Medicare program, where costs are expected to rise dramatically as new treatments are developed and a generation of Baby Boomers enters retirement. Burgeoning health care costs, it seems certain, will be near the top of Washington, DC’s agenda for years to come.
As they work to reduce health care costs and extend the solvency of programs like Medicare, policymakers will confront tough choices in the months and years ahead. Yet, they must also be alert for reforms that cut costs while maintaining quality services for beneficiaries. This analysis by Professor Brent Fulton and Dr. Sue Kim of the University of California at Berkeley explores one possible way for policymakers to generate substantial Medicare savings without reducing services or quality of care.
This study examines ambulatory surgery centers (ASCs). ASCs are technologically advanced medical facilities that provide same-day surgical procedures, including important diagnostic and preventive services like colonoscopies. Today, more than 5,300 Medicare-certified ASCs serve communities throughout our nation. These ASCs perform many of the same procedures as hospital outpatient departments (HOPDs). ASCs, however, are able to provide care much more efficiently and without the often costly overhead associated with hospitals. According to an industry calculation, the Medicare program currently reimburses ASCs at 58 percent of the HOPD rate, meaning that Medicare—and the taxpayers who fund it—realize savings every time a procedure is performed in an ASC instead of an HOPD.
When one considers the millions of same-day surgical procedures performed in ASCs through the Medicare program each year, the nationwide savings add up quickly. In this study, University of California at Berkeley’s Professor Brent Fulton and Dr. Sue Kim analyze the numbers to determine how much ASCs save the Medicare program and its beneficiaries. They begin by analyzing government data to identify how much money ASCs saved Medicare in recent years, and then, forecast how much more ASCs will save Medicare in the future. The key findings are the following:
• During the four-year period from 2008 to 2011, ASCssaved the Medicare program and its beneficiaries $7.5 billion.ASCs savedMedicareand itsbeneficiaries$2.3billionin2011alone.
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• $6billionofthesesavingswererealizedbythefederalMedicare program. The remaining $1.5 billion wentdirectly to Medicare beneficiaries. In other words, Medicarepatientsnationwidesaved$1.5billionthanksto the less expensive care offered at ASCs.
• ASCshavethepotentialtosavetheMedicareprogramand itsbeneficiariesup to$57.6billionmoreover thenext decade.
• Beneficiariesthemselvesalsostandtosaveconsiderablyin future years. Because Medicare reimburses ASCs at a lower rate than HOPDs, patients also pay a smaller coinsurance amount in an ASC. The authors use the example of cataract surgery, noting that a Medicare beneficiary will save $148 on his or her coinsuranceby electing to undergo surgery in an ASC instead of a hospital.
These findings have important implications for policymakers’ ongoing discussion about how to most effectively reduce health care costs and the national budget deficit. The clearest implication is that, while public officials may indeed confront tough choices in the years ahead, the choice to encourage ASC use within the Medicare program is an easy decision. These findings suggest that ASCs offer a “win–win” for patients and the Medicare system, since they provide substantial savings without any corresponding reduction in quality or benefits.
While the future savings offered by ASCs are easily attainable, however, they are not inevitable. Indeed, a discrepancy in Medicare reimbursement policy could jeopardize the savings ASCs provide. Medicare uses two different factors to update ASC and HOPD payments—despite the fact that the two settings provide the same surgical services. ASC payments are updated based on the consumer price index for all urban consumers (CPI-U), which measures changes in the costs of all consumer goods; HOPD rates, meanwhile, are updated on the hospital market basket, which specifically measures changes in the costs of providing health care, and so, more accurately reflects the increased costs that outpatient facilities face.
Since consumer prices have inflated more slowly than medical costs, the gap in ASC and HOPD reimbursement
rates has widened over time. If the reimbursement rate for ASCs continues to fall relative to their HOPD counterparts, ASC owners and physicians will face increasing pressure to leave the Medicare system and allow their facilities to be acquired by nearby hospitals. When an ASC is acquired by a hospital, the Medicare reimbursement rate jumps roughly 75 percent. This threatens to turn the cost-saving advantage of ASCs into a perverse market incentive that drives ASCs from the Medicare program.
Already, the widening disparity in reimbursement has ledmore than 60 ASCs to terminate their participation inMedicare over the last three years. If the reimbursement gap continues to widen, more ASCs will leave the Medicare program. As a result, more Medicare cases will be driven to the HOPD, causing costs to both the Medicare program and its beneficiaries to rise.
Thus, realizing the full potential savings that ASCs offer will likely require policymakers to step in and halt this continuing “slide” in ASC reimbursement rates. Because Medicare saves money virtually every time a procedure is performed in an ASC instead of an HOPD, any policies that reduce the widening reimbursement gap between ASCs and HOPDs, and that otherwise encourage the migration of cases from the hospital setting into ASCs, will increase total savings for the Medicare program and its beneficiaries.
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I. AN INTRODUCTION TO AMBULATORY SURGERY CENTERS Only 40 years ago, virtually all surgeries and diagnosticprocedures were performed in hospitals. Today, however, standalone facilities known as Ambulatory Surgery Centers (ASCs) provide outpatient surgical care in an atmosphere removed from the competing demands that are often encountered in an acute care hospital.
ASCs, as this report details, offer patients a cost-effective alternative to hospital outpatient departments (HOPDs). The first ASC opened in 1970, and today, there are morethan 5,300 Medicare-certified ASCs in the United States. The overwhelming majority of these ASCs are at least partially owned by physicians, which allows for better control over scheduling, as procedures are not often delayed or rescheduled due to staffing issues or competing demands for operating room space from emergency cases.
ASC surgeons perform a diverse range of procedures, many of them diagnostic or preventive in nature. For example:
• ASCs perform more than 40 percent of all Medicarecolonoscopies, contributing to a decade-long decline in colorectal cancer mortality.
• TheASCindustryalsoledthedevelopmentofminimallyinvasive procedures and the advancement of technology to replace the intraocular lens, a procedure that is now used nearly one million times each year to restore vision for Medicare patients with cataracts. Once an inpatient hospital procedure, it can now be performed safely at an ASC at a much lower cost.
What is an ASC?
Ambulatory Surgery Centers are modern health care facilities focused on providing a range of same-day surgical care, the same types of procedures that were once performed exclusively in hospitals. Today, as a result of medical advancements and new technologies—including minimally invasive surgical techniques and improved anesthesia—a range of procedures can be performed safely and effectively on an outpatient basis.
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II. ASCS: SAVING THE SYSTEM
The more than 5,300 Medicare-certified ASCs in the United States today provide identical services to those performed at HOPDs throughout the country. ASCs are able to perform these surgeries much more efficiently than HOPDs. ASCs do not incur the often substantial administrative and overhead costs associated with a hospital. This enables ASCs to provide these services at substantially less cost to the Medicare program—and to its beneficiaries—than their hospital counterparts.
Today, Medicare reimburses ASCs at an average of 58 percent of the rate it reimburses HOPDs for the same procedures.
The savings that accrue over time, even for individual procedures,are significant.Forexample, in2011,Medicarebeneficiaries (excluding Medicare Advantage beneficiaries) had 1,709,175 cataract surgeries, ofwhich, 1,120,388wereperformed in ASCs and the other 588,787 in HOPDs. The parallel reimbursements per surgery were $951 for anASC and $1,691 for an HOPD, meaning that every time apatient elected to receive treatment in an ASC, the Medicare program saved $740. When applied across the 1,120,388cataractsurgeriesperformedinASCsduring2011,thetotalsavingsforthissingleprocedurereached$829million.
58%
of the rate it reimburses HOPDs
On average, Medicare reimburses ASCs
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III. COST SAVINGS ANALYSIS
Data and Methodology
Professor Fulton and Dr. Kim conducted the following analysis, which looks at government data from the Centers for Medicare & Medicaid Services (CMS), to answer two fundamental questions. First, how much money did the Medicare program and its beneficiaries save from 2008 to2011 because surgical and diagnostic procedures wereperformed at ASCs instead of HOPDs? Second, how much more could the Medicare program and its beneficiaries save over thenextdecade (2013–2022) ifadditionalproceduresmove from HOPDs to the ASC setting during that timeframe?
Government data was used to ascertain the volume of procedures performed in ASCs, HOPDs and physician offices from2008through2011,aswellasthereimbursementratesfor procedures done at ASCs and HOPDs. The volume data reports are from the Medicare Physician Supplier Procedure Specific file available from CMS. It excludes Medicare Advantage enrollees. The ASC reimbursement rates are from the ASC Addendum AA1, and the HOPD reimbursement rates are from Hospital Outpatient Prospective Payment System Addendum.2
When forecasting future cost savings, the Berkeley analysts relied on CMS’ predicted number of Medicare beneficiaries from 2013 to 2022. This data set also excludes MedicareAdvantage enrollees.3
To ensure a realistic baseline for their analysis and predictions, theanalystslimitedthedatasettothe120proceduresmostcommonlyperformedatASCsin2011,whichrepresented73percent of the total volume of all procedures performed in ASCsin2011.4
Past Savings
ToestimatethesavingsgeneratedbyASCsfrom2008to2011,the analysts calculated the differences in reimbursement rates for eachof the 120procedures, thenmultiplied thosedifferences by the number of procedures performed at ASCs. For example, the cataract surgery discussed in the previous section,whenperformedinanASC,generatedatotalof$829millioninsavingsin2011.Theyappliedthesamemethodforallofthe120proceduresineachyearfrom2008to2011.Theybroke the numbers into savings that accrued to the Medicare program and savings that directly benefited beneficiaries. Thebeneficiaryshareofthetotalsavingswas20percentoverthe four-year period. Professor Fulton’s and Dr. Kim’s analysis found the following:
• Duringthefour-yearperiodfrom2008to2011,thelowerASC reimbursement rate generated a total of $7.5 billion in savings for the Medicare program and its beneficiaries.
• $6billionofthesesavingswererealizedbythefederalMedicare program. The remaining $1.5 billion wassaved by Medicare beneficiaries themselves. In other words,Medicarepatientsnationwidesaved$1.5billionthanks to the less expensive care offered at ASCs.
• These savings increased each year, rising from $1.5billionin2008to$2.3billionin2011.Theincreaseresultsfromthetotalnumberofproceduresgrowingfrom20.4millionto24.7million(or6.6percentannually)between2008and2011aswellas thereimbursementrategapwidening between HOPDs and ACSs. These savings were realized despite the share of total Medicare procedures performed in ASCs decreasing over this period, falling from22.9percentin2008to21.7percentin2011.
1http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html2http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html 3 http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2011.pdf(p.51).4Thedatasetwasinitiallynarrowedto148procedures,whichrepresentedabout90%ofthetotalvolume.Twenty-sevenproceduresweredroppedbecauseof
missingdataonthenumberofproceduresorreimbursementrates.OneadditionalprocedurewasdroppedtheASCsharewas100%,anditthusprovidednobasis for comparison with HOPDs.
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These findings are illustrated in the following chart.
Notes: * The ASC share reported in the table is influenced by (or weighted for) high-volume procedures, such as cataracts. The analysts also calculated theASCsharebasedonasimpleaverageacrossthe120procedures.TheASCsharesfor2008to2011were30.4%,31.0%,31.4%and31.8%,respectively,eachyear,andaveraged31.1%overthefouryears.
**Savings are reported in nominal dollars.
***Totalsmaynotsumandpercentagesmaynottotalto100%duetorounding.
Descriptor Annual Change
Total (2008—2011) 2008 2009 2010 2011
Numberofproceduresper1,000Medicare beneficiaries
Procedures (million)
ASC
HOPD
Physician office
Total # of procedures
ASC share*
Savings ($billion) **
Program
Beneficiaries
Total***
5.6%
4.7%
5.9%
7.7%
6.6%
1.5%
16.6%
14.8%
16.3%
19.5
22.3
45.5
87.3
22.3%
$6.0
$1.5
$7.5
573.9
4.7
5.3
10.4
20.4
22.9%
$1.2
$0.3
$1.5
587.3
4.7
5.3
10.8
20.8
22.7%
$1.4
$0.4
$1.8
600.3
4.8
5.4
11.3
21.5
22.3%
$1.5
$0.4
$1.9
674.9
5.4
6.3
13.0
24.7
21.7%
$1.9
$0.5
$2.3
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Future Savings
The ASC industry is certain to continue generating savings to both the Medicare program and its beneficiaries over the next decade. The magnitude of these savings, however, will hinge on whether, and how much, the ASC share of surgeries grows within the Medicare program. That growth rate will, in turn, depend on market trends, demographic factors and how policymakers act—or decline to act—to encourage the use of ASCs within the Medicare program.
To estimate the savings Medicare would realize from having more procedures performed in ASCs from 2013 to 2022,Professor Fulton and Dr. Kim applied the methodology above to six scenarios. These six scenarios, which incorporate different assumptions about both the growth of ASC share and the overall growth of Medicare procedure rates, provide a range of possible savings offered by ASCs in the next decade.
The analysts divided the scenarios into two subsets. For subset A, they assumed that the number of procedures per 1,000Medicarebeneficiarieswould remainconstantat the2010 rate. For subset B, they assumed that the 2011 ratewould increase by 3 percent annually for each procedure.5 Within each subset, the analysts examined three scenarios:
1. TheASC share of each procedure in 2011will remainconstant between 2013 and 2022. This is a baseline assumption that assumes ASC share does not grow at all in the coming decade.
2. The ASC share of each procedure will increase by 2percent per year from 2013 through 2022, equivalentto the average increase across procedures from 2008through2011.6 The analysts capped the share for any given procedure at 90 percent to avoid implausibleassumptions.
3. The ASC share growth for each procedure will vary depending on that procedure’s historical share growth rate. The analysts assumed three growth rates and, again,cappedtheshareforanysingleprocedureat90percent.
• The “low” group included procedures that hadnegative or no growth in the share of procedures performedatASCsduring2008–2011.Theanalystsassumed that the ASC share of these procedures will increase1percent annually from2013–2022.This group included approximately 30 percent of the procedures.
• The“middle”group includedproceduresthathadup to 5 percent growth in share of procedures performed at ASCs during 2008–2011. It wasassumed that the ASC share of these procedures will increase5percent annually from2013–2022.This group includedapproximately 43percentofthe procedures.
• The “high” group included procedures thathad greater than 5 percent growth in share of proceduresperformedatASCsduring2008–2011.This group had a median ASC share growth rate of about 11 percent annually during 2008–2011.The analysts projected that the ASC share of these procedureswillincrease10percentannuallyfrom2013–2022.Thisgroupincludedapproximately27percent of the procedures.
The estimated savings are tabulated in the following table. The savings analysis and predictions for each individual procedure are tabulated in the appendix.
5Thenumberofproceduresper1,000Medicarebeneficiariessignificantlyincreasedbetween2010and2011(seetableonpage9).Forthelower-savingsestimates(subsetA),thelower2010ratewasusedasabaseline.Forthehigher-savingsestimates(subsetB),the2011ratewasusedasthebaseline.
6The2%annualaverageincreaseisbasedonasimpleaverageacrossthe120procedures,meaningtheaverageisnotinfluencedby(orweightedfor)forhigh-volume procedures, such as cataracts.
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Note: Savings are reported in nominal dollars. In all scenarios, the Berkeley analysts inflated the reimbursement amounts over timeusingaforecastedConsumerPriceIndexforAllUrbanConsumers,whichaveraged2.4%from2013–2022.
Projected Savings ($Billion) 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
2013-2017
2018-2022
2013-2022
A. Volume of Procedures per 1,000 Medicare Beneficiaries Remains Constant and:
A1.ASCshareremainsconstant
A2.ASCshareincreasesat2%annually
A3. ASC share increases either1%,5%or10%annually (depending on the procedure)
B. Volume of Procedures per 1,000 Medicare Beneficiaries Increases by 3% Annually and:
B1.ASCshareremainsconstant
B2.ASCshareincreasesat2%annually
B3. ASC share increases either1%,5%or10%annually (depending on the procedure)
$2.3
$2.4
$2.5
$2.5
$2.7
$2.8
$2.8
$3.0
$3.1
$3.0
$3.3
$3.5
$3.2
$3.6
$3.8
$3.3
$3.8
$4.2
$3.5
$4.1
$4.6
$3.7
$4.4
$5.0
$4.0
$4.8
$5.5
$4.2
$5.2
$6.0
$13.7
$14.9
$15.7
$18.7
$22.5
$25.3
$32.5
$37.3
$41.0
$2.8
$2.9
$3.0
$3.1
$3.3
$3.5
$3.5
$3.8
$4.0
$3.9
$4.3
$4.6
$4.3
$4.8
$5.2
$4.7
$5.4
$5.8
$5.1
$5.9
$6.6
$5.5
$6.6
$7.4
$6.0
$7.4
$8.3
$6.6
$8.2
$9.4
$17.6
$19.1
$20.2
$27.9
$33.4
$37.5
$45.5
$52.6
$57.6
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Conclusions
ASCs saved the Medicare program and its beneficiaries $7.5 billion over the four-year period from 2008 to 2011. Evenunder the most conservative assumptions, the future savings generated by ASCs are substantial.
• Under the baseline scenario, which assumes thatneither ASC share nor Medicare procedure volume will grow over the next decade, ASCs will save the Medicare programanadditional$32.5billionduringthattime.
• As the share of procedures performed in ASCs growswithin the Medicare program, so do the savings. If ASC share within the Medicare system increases even slightly, as in scenarios B2 and B3, the savings couldexceed$57.6billionover10years—anaveragesavingsof$5.76billioneachyear.
• Medicare beneficiaries also save money by choosingASCs, since a lower Medicare reimbursement rate means that patients, in turn, pay a smaller coinsurance. While the forward-looking portion of this study does not examine coinsurance rates for each procedure, it is clear that the savings realized by the Medicare program imply additional savings for beneficiaries. Using the example of cataract surgeries: a Medicare beneficiary willpaycoinsuranceof$338.20forsuchasurgerytobeperformedinanHOPD,butonly$190.20forthatsamesurgeryinanASC—a$148savingsthatgoesdirectlytothe patient.
Further, the above estimates are quite conservative. Even the most “optimistic” scenario assumes that ASC share growth per procedure grows only modestly more quickly than historical averages, and that Medicare volume grows at a modest, and historically consistent, rate. If policy decisions or other factors cause either growth rate to accelerate further, the savings generated by ASCs within the Medicare system wouldcertainlyexceedthe$57.6billionestimatedhere.
$57.6 billionadditional savings in Medicare program generated byASCsoverthenext10years
$5.76 billionaverage future yearly savings
BY THE NUMBERS:
$7.5 billioninsavingsgeneratedbyASCSfrom2008to2011
A final note: although this study examined only data from the Medicare program, ASCs typically also charge private payers, including those in the Medicare Advantage program, less than their HOPD counterparts. Thus, similar cost savings also exist in the commercial health insurance market and in the Medicare Advantage program. We believe it is important to quantify these private-side savings as well and encourage others to examine this subject in future studies.
Up to
Up to
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IV. POLICY IMPLICATIONS AND CONSIDERATIONSAn aging population, along with inflation in health care costs, means that the federal government’s expenditures through the Medicare program are projected to increase substantially in the coming years. Consequently, policymakers in Washington, DC, are exploring potential ways to reduce projected Medicare outlays and extend the program’s solvency. We believe that this study offers an important contribution to that discussion. Two specific policy concerns stand out.
AVOIDING ASC TO HOPD CONVERSIONS
Our first and most important observation is that, while the future savings offered by ASCs are easily attainable, they are not inevitable. Because they provide identical services to HOPDs but do so at an average of 58 percent of the reimbursement rate that the Medicare program pays HOPDs for those services, ASCs represent a source of value to the program and the taxpayers who fund it. A discrepancy in the way Medicare reimbursement rates are updated, however, threatens to marginalize ASCs’ role within the program.
CMS currently applies different measures of inflation to determine the adjustments it provides to its payment systems for ASCs and HOPDs each year. For ASCs, that measure is the CPI-U, which is tied to consumer prices. The index for HOPD reimbursements, on the other hand, remains tied to the hospital market basket, which measures inflation in actual medical costs. Since consumer prices have inflated more slowly than medical costs, the gap in ASC and HOPD reimbursement rates has widened over time. As the reimbursement rate for ASCs continues to fall relative to their HOPD counterparts, ASC owners and physicians will face increasing pressure to leave the Medicare system and allow their facilities to be acquired by nearby hospitals.
When an ASC is acquired by a hospital, in what is known as “an ASC to HOPD conversion,” the Medicare reimbursement rate jumps roughly 75 percent and all savings to the Medicare program and its beneficiaries are promptly lost. The
continuing reduction in reimbursement ledmore than 60ASCs to terminate their participation in Medicare over the last three years. If policymakers allow this gap in reimbursements to continue widening, the cost-saving advantage that ASCs offer could morph into a perverse market incentive that drives ASCs from the Medicare program.
Some in Congress have introduced legislation, which is titled the “Ambulatory Surgical Center Quality and Access Act,” that aims to fix this problem. This bill would correct the imbalance in reimbursement indices and ensure that ASC reimbursements do not continue to fall relative to their HOPD counterparts. Additionally, it would establish an ASC value-based purchasing (VBP) program designed to foster collaboration between ASCs and the government and create additional savings for the Medicare system in the process.
ASCS AS PART OF BROADER COST-SAVINGS EFFORTS
Many of the policy options aimed at reducing Medicare costs that are being considered in Congress today involve important “trade-offs,” where reduced outlays come at the expense of retirees’ benefits. Often-discussed options such as raising the Medicare retirement age or increasing cost-sharing, for example, generate savings as a direct result of reducing the amount of benefits delivered by the Medicare program. The savings offered by ASCs, however, do not involve such trade-offs; they make it possible for the Medicare program, and its beneficiaries, to realize significant savings without any corresponding reduction in benefits.
There are more than 5,300 Medicare-certified ASCs throughout the country, all of which represent an important source of efficiency for the Medicare program and the taxpayers who fund it. We recommend that policymakers explore all potential options for encouraging further growth of ASC share within the Medicare system.
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APPENDIX: METHODOLOGY AND CHART OF INDIVIDUAL PROCEDURE SAVINGS
Thefollowingtableshowsdetailedstatisticsforthe120procedures.Inthetable,theproceduresarefirstsortedbytheannualASCshareincreaseassumptionsinScenariosA3andB3,whichwere1,5,and10percentannually(seeColumn“%ASCShareGrowthAssumptionsforA3andB3”).Withinthe1,5,and10percentbuckets,theproceduresarethensortedbasedonthesavingstheygeneratedin2011(seeColumn“Savings2011”).
ThetableshowstheaverageannualchangeintheASCsharefrom2008through2011,the2011ASCshareofproceduresandprojectedASCsharein2022iftheshareincreasesby2percentannuallyorintherangeof1to10percentannually.Inaddition,itshowsthe2011andprojected2022volumeper1,000Medicarebeneficiaries.Mostimportantly,thosecolumnsarefollowedbytwosetsofthreecolumnsthatshowtheprojectedsavingsestimatesin2022whenthenumberofproceduresper1,000Medicarebeneficiariesremainsconstantandwhenthenumberofproceduresper1,000Medicarebeneficiariesincreasesby3percentperyear.Withineachset,theASCshareassumptionsarebasedontheassumptionspresentedinthetableonpage11.
Thefirstrowofthetableillustratesthatcataractsurgeries(HCPCS66984)alonegeneratedasavingsof$829millionin2011.In2011,theASCshareofthisprocedurewas56percent,andthatshareeitherincreasesto62or69percentdependingonthescenario.Dependingonwhetherthenumberofcataractsurgeriesper1,000MedicarebeneficiariesincreasesandtheshareofproceduresperformedinASCs,theprojectedsavingsforMedicareanditsbeneficiariesrangefrom$1.5billionto$2.95billionin2022.
Thelastrowofthetableshowscolumntotalsandaverages(seepage9).In2011,therewere$2.3billioninsavingsforthe120procedures,andtheprojectedsavingsin2022rangefrom$4.2billionto$9.4billion,dependingonthescenario.
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
HCPC
S Des
crip
tion
No.
HCPC
S
Savi
ngs
2011
($
mill
ion)
Aver
age
Annu
al
ASC S
hare
Ch
ange
20
08-2
011
Base
line:
20
11 AS
C Sh
are o
f Pr
oced
ures
Proj
ecte
d AS
C Sha
re
for 2
022
(2%
in
creas
e pe
r yea
r)
Proj
ecte
d AS
C Sha
re
for 2
022
(shar
e in
creas
e va
ries)
2011
Vo
lum
e of
Proc
e-du
res (
# pe
r 1,0
00
Med
icare
Be
ne-
ficiar
ies)
Proj
ecte
d Vo
lum
e of
Proc
e-du
res f
or
2022
(#
per 1
,000
M
edica
re
Bene
- fic
iaries
)*
A1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
A2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
A3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies Re
main
s Con
stant
B1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
B2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
B3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies In
creas
es By
3% pe
r Yea
r
% AS
C An
nual
Sh
are
Grow
th
Assu
mp-
tion f
or A
3 &
B3
Reim
burse
-m
ent
Diffe
renc
e Be
twee
n AS
Cs an
d HO
PDs
2011
6698
466
982
6448
362
311
6682
129
881
2828
543
235
6462
252
000
6231
029
848
2982
363
650
2068
028
296
5200
545
381
3656
129
875
3052
052
281
5855
865
426
6462
614
041
4325
164
627
4436
162
264
Cata
ract
surg
w/io
l 1 st
age
Cata
ract
surg
ery c
omple
xIn
j fora
men
epidu
ral l/
sIn
ject s
pine l
/s (cd
)Af
ter c
atar
act l
aser
surg
ery
Knee
arth
rosco
py/su
rger
yRe
pair o
f ham
mer
toe
Uppr
gi en
dosco
py di
agno
sisDe
str pa
rave
rtebr
l ner
ve l/
sCy
stosco
pyIn
ject s
pine c
/tW
rist e
ndos
copy
/surg
ery
Shou
lder a
rthro
scopy
/surg
ery
Impla
nt ne
uroe
lectro
des
Rem
oval
of su
ppor
t im
plant
Corre
ction
of bu
nion
Cysto
scopy
& ur
eter
cath
eter
Colon
osco
py su
bmuc
ous i
njIn
sert
tunn
eled c
v cat
hKn
ee ar
thro
scopy
/surg
ery
Repa
ir of n
asal
sept
umCy
stosco
py an
d tre
atm
ent
Hyste
rosco
py bi
opsy
Rem
oval
of ey
e les
ionDe
str pa
rave
rtebr
l ner
ve c/
tSk
in tis
sue r
earra
ngem
ent
Oper
ative
uppe
r GI e
ndos
copy
Destr
para
verte
bral
n add
-on
Small
bowe
l end
osco
py/b
iopsy
Epidu
ral ly
sis on
sing
le da
y
$829
$63
$60
$53
$43
$25
$22
$21
$18
$16
$14
$11
$10
$9 $7 $7 $7 $7 $6 $5 $5 $5 $4 $3 $3 $3 $2 $2 $2 $2
-3.56
%-0
.96%
-3.02
%-1
3.67%
-2.96
%-0
.25%
-0.22
%-0
.18%
-4.98
%-0
.03%
-13.5
4%-0
.10%
-2.73
%-2
0.87%
-1.14
%-0
.91%
-0.11
%-4
.10%
-1.43
%-1
.21%
-0.30
%-0
.75%
-2.25
%-0
.03%
-7.96
%-2
.49%
-0.85
%-0
.43%
-1.36
%-1
7.63%
56%
52%
35%
26%
43%
39%
37%
34%
35%
8% 30%
51%
28%
24%
26%
41%
25%
43%
7% 46%
30%
9% 13%
59%
38%
13%
35%
39%
53%
29%
69%
65%
44%
33%
54%
48%
46%
43%
44%
10%
37%
63%
35%
29%
32%
50%
31%
54%
8% 57%
37%
11%
17%
73%
48%
16%
44%
48%
66%
36%
62%
59%
39%
29%
48%
43%
41%
38%
40%
9% 33%
57%
31%
26%
29%
45%
28%
48%
7% 51%
34%
10%
15%
66%
43%
15%
39%
43%
60%
32%
54.9
4.4 20.6
24.1
16.2
2.0 2.4 6.1 3.6 24.4
5.5 0.7 0.7 1.2 1.1 0.5 0.9 1.5 2.6 0.3 0.6 2.7 1.1 0.2 0.8 1.0 0.6 1.9 0.3 0.4
76.0
6.1 28.5
33.4
22.4
2.7 3.3 8.5 5.0 33.8
7.6 0.9 0.9 1.7 1.5 0.7 1.3 2.0 3.7 0.4 0.8 3.7 1.5 0.2 1.2 1.4 0.9 2.6 0.5 0.5
$1,50
0$1
16$1
06$7
3$8
6$5
1$3
8$3
8$2
8$3
3$1
8$2
0$1
4$1
0$1
4$1
5$1
2$7 $1
2$8 $8 $1
1$7 $5 $4 $5 $4 $3 $4 $2
$1,87
0$1
44$1
32$9
1$1
07$6
4$4
7$4
7$3
4$4
1$2
3$2
5$1
7$1
2$1
7$1
8$1
5$9 $1
5$1
0$9 $1
3$9 $6 $5 $6 $5 $3 $5 $2
$1,67
0$1
29$1
19$8
2$9
6$5
7$4
3$4
2$3
1$3
7$2
0$2
3$1
6$1
1$1
5$1
7$1
3$8 $1
3$9 $8 $1
2$8 $6 $5 $6 $4 $3 $4 $2
$2,37
0$1
80$1
73$1
52$1
24$7
1$6
4$5
9$5
2$4
7$3
9$3
2$2
9$2
6$2
1$2
0$1
9$1
9$1
7$1
4$1
4$1
4$1
0$8 $8 $7 $6 $6 $6 $5
$2,95
0$2
24$2
15$1
88$1
54$8
9$7
9$7
3$6
4$5
8$4
9$4
0$3
6$3
2$2
7$2
5$2
4$2
3$2
1$1
7$1
7$1
7$1
3$1
0$1
0$9 $8 $8 $7 $6
$2,65
0$2
01$1
93$1
69$1
38$7
9$7
1$6
6$5
8$5
2$4
4$3
6$3
2$2
9$2
4$2
3$2
2$2
1$1
9$1
5$1
5$1
5$1
2$9 $9 $8 $7 $7 $6 $5
1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
$740
$740
$229
$229
$169
$903
$681
$268
$386
$224
$229
$903
$1,46
0$8
46$7
20$1
,002
$794
$281
$927
$903
$773
$530
$696
$736
$229
$519
$268
$80
$307
$386
M E D I C A R E C O S T S A V I N G S T I E D T O A M B U L A T O R Y S U R G E R Y C E N T E R S1 6
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
1313
262
319
6452
064
450
1104
220
552
4323
945
380
4538
545
378
2982
6G0
105
6472
164
623
G012
129
827
2988
045
384
6790
464
484
2605
543
248
2982
449
505
6791
723
412
1406
055
700
6618
043
450
Repa
ir of w
ound
or le
sion
Injec
t spin
e w/ca
th l/
s (cd
)N
block
lum
bar/t
hora
cicN
block
othe
r per
ipher
alDe
b sub
q tiss
ue 20
sq cm
/<In
j trig
ger p
oint 1
/2 m
uscl
Uppe
r gi e
ndos
copy
biop
syCo
lonos
copy
and b
iopsy
Lesio
n rem
oval
colon
osco
pyDi
agno
stic c
olono
scopy
Shou
lder a
rthro
scopy
/surg
ery
Color
ecta
l scrn
; hi ri
sk in
dCa
rpal
tunn
el su
rger
yDe
str pa
rave
rtebr
al n a
dd-o
nCo
lon ca
scrn
not h
i rsk i
ndAr
thro
scop r
otat
or cu
ff re
prKn
ee ar
thro
scopy
/surg
ery
Lesio
n rem
ove c
olono
scopy
Repa
ir eye
lid de
fect
Inj fo
ram
en ep
idura
l add
-on
Incis
e fing
er te
ndon
shea
thUp
pr gi
endo
scopy
/guid
e wire
Shou
lder a
rthro
scopy
/surg
ery
Prp i
/her
n init
redu
c >5 y
rRe
pair e
yelid
defec
tRe
pair r
otat
or cu
ff ch
ronic
Skin
tissu
e rea
rrang
emen
tBi
opsy
of pr
osta
teIm
plant
eye s
hunt
Dilat
e eso
phag
us
$2 $2 $1 $1 $1 $1 $143
$107
$82
$66
$38
$30
$25
$24
$24
$23
$21
$19
$17
$16
$16
$14
$11
$11
$10
$10
$9 $8 $8 $8
-4.69
%-1
8.47%
-13.7
4%-1
.62%
-14.4
8%-7
.74%
0.58%
1.11%
2.10%
0.27%
1.27%
2.48%
1.01%
4.03%
2.22%
3.71%
1.64%
0.93%
3.55%
3.71%
1.20%
0.86%
0.45%
2.77%
3.72%
3.46%
0.50%
2.92%
3.44%
1.82%
6% 30%
23%
1% 1% 1% 45%
48%
46%
40%
33%
52%
40%
36%
45%
32%
41%
42%
63%
34%
44%
53%
33%
15%
60%
33%
18%
12%
52%
54%
7% 38%
29%
2% 1% 2% 55%
59%
58%
49%
40%
64%
50%
44%
56%
39%
51%
52%
79%
42%
55%
67%
42%
19%
74%
41%
22%
14%
65%
67%
6% 34%
26%
1% 1% 1% 76%
82%
79%
68%
56%
88%
68%
61%
77%
54%
71%
71%
90%
58%
76%
90%
57%
26%
90%
56%
30%
20%
89%
90%
5.3 0.4 0.6 10.2
28.9
8.3 32.8
21.8
17.2
16.2
2.2 6.3 3.0 8.1 5.8 1.4 1.5 4.5 1.2 11.2
1.9 2.6 1.0 1.9 0.8 0.6 2.6 5.1 0.3 1.9
7.4 0.5 0.8 14.1
40.0
11.5
45.5
30.2
23.9
22.4
3.1 8.7 4.2 11.2
8.0 1.9 2.1 6.3 1.7 15.6
2.7 3.6 1.4 2.7 1.0 0.8 3.6 7.0 0.4 2.7
$2 $2 $1 $1 $1 $1 $243
$197
$162
$157
$53
$54
$50
$31
$42
$44
$44
$40
$32
$23
$28
$25
$15
$23
$18
$20
$18
$17
$16
$8
$3 $2 $2 $1 $2 $1 $303
$245
$202
$195
$66
$68
$62
$39
$52
$55
$55
$49
$40
$29
$35
$31
$19
$28
$23
$25
$22
$21
$20
$11
$3 $2 $2 $1 $2 $1 $416
$336
$278
$268
$91
$93
$85
$53
$72
$75
$76
$68
$46
$40
$49
$42
$26
$39
$27
$34
$30
$29
$27
$14
$5 $4 $3 $3 $2 $2 $409
$306
$236
$190
$110
$85
$72
$69
$68
$66
$59
$56
$48
$46
$46
$39
$32
$30
$28
$27
$25
$24
$22
$22
$6 $6 $4 $4 $3 $2 $509
$380
$293
$236
$137
$105
$90
$86
$84
$82
$73
$69
$60
$58
$58
$49
$40
$38
$35
$34
$31
$30
$27
$27
$5 $5 $4 $3 $2 $2 $700
$523
$403
$324
$188
$145
$124
$118
$115
$112
$100
$95
$69
$79
$79
$66
$55
$52
$43
$47
$43
$42
$38
$36
1% 1% 1% 1% 1% 1% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5%
$140
$386
$229
$226
$82
$163
$268
$281
$281
$281
$1,46
0$2
49$5
77$2
29$2
49$1
,460
$903
$281
$603
$117
$517
$268
$903
$997
$603
$1,42
6$5
19$3
93$1
,303
$198
HCPC
S Des
crip
tion
No.
HCPC
S
Savi
ngs
2011
($
mill
ion)
Aver
age
Annu
al
ASC S
hare
Ch
ange
20
08-2
011
Base
line:
20
11 AS
C Sh
are o
f Pr
oced
ures
Proj
ecte
d AS
C Sha
re
for 2
022
(2%
in
creas
e pe
r yea
r)
Proj
ecte
d AS
C Sha
re
for 2
022
(shar
e in
creas
e va
ries)
2011
Vo
lum
e of
Proc
e-du
res (
# pe
r 1,0
00
Med
icare
Be
ne-
ficiar
ies)
Proj
ecte
d Vo
lum
e of
Proc
e-du
res f
or
2022
(#
per 1
,000
M
edica
re
Bene
- fic
iaries
)*
A1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
A2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
A3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies Re
main
s Con
stant
B1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
B2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
B3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies In
creas
es By
3% pe
r Yea
r
% AS
C An
nual
Sh
are
Grow
th
Assu
mp-
tion f
or A
3 &
B3
Reim
burse
-m
ent
Diffe
renc
e Be
twee
n AS
Cs an
d HO
PDs
2011
M E D I C A R E C O S T S A V I N G S T I E D T O A M B U L A T O R Y S U R G E R Y C E N T E R S 1 7
61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90
2544
743
249
6617
029
822
1404
028
270
1526
045
383
6671
167
924
5235
367
028
5223
464
718
2830
826
123
2616
067
950
5222
452
310
6796
152
235
6698
664
479
6625
014
061
1731
113
121
1582
350
590
Repa
ir wris
t join
t(s)
Esop
h end
osco
py di
lation
Glau
com
a sur
gery
Shou
lder a
rthro
scopy
/surg
ery
Skin
tissu
e rea
rrang
emen
tRe
lease
of fo
ot co
ntra
cture
Skin
full g
raft
een &
lips
Lesio
n rem
oval
colon
osco
pyCil
iary e
ndos
copic
ablat
ionRe
pair e
yelid
defec
tCy
stour
eter
o w/li
thot
ripsy
Injec
tion e
ye dr
ugCy
stosco
py an
d tre
atm
ent
Revis
e uln
ar ne
rve a
t elbo
wIn
cision
of m
etat
arsa
lRe
lease
palm
cont
ractu
reRe
mov
e ten
don s
heat
h les
ionRe
vision
of ey
elid
Cysto
scopy
and t
reat
men
tCy
stosco
py an
d tre
atm
ent
Revis
ion of
eyeli
dCy
stosco
py an
d tre
atm
ent
Exch
ange
lens
pros
thes
isIn
j fora
men
epidu
ral c
/tFo
llow-
up su
rger
y of e
yeSk
in tis
sue r
earra
ngem
ent
Moh
s 1 st
age h
/n/h
f/gRe
pair o
f wou
nd or
lesio
nRe
vision
of up
per e
yelid
Fragm
entin
g of k
idney
ston
e
$7 $7 $6 $6 $6 $5 $5 $5 $5 $5 $4 $4 $4 $4 $3 $3 $3 $3 $3 $3 $3 $3 $3 $3 $2 $2 $1 $1 $41
$13
1.12%
1.08%
4.40%
2.28%
1.83%
3.02%
4.70%
1.36%
1.70%
3.72%
4.90%
3.19%
1.27%
3.70%
1.92%
1.37%
0.77%
2.29%
4.95%
0.06%
1.27%
2.23%
0.17%
0.16%
1.83%
1.01%
3.76%
0.48%
6.61%
10.88
%
47%
30%
61%
36%
16%
28%
18%
36%
79%
61%
13%
1% 19%
36%
38%
47%
44%
64%
8% 9% 55%
14%
63%
31%
37%
16%
1% 6% 68%
18%
58%
38%
76%
45%
20%
35%
22%
45%
90%
76%
16%
1% 24%
45%
48%
58%
55%
80%
11%
11%
69%
18%
78%
38%
46%
19%
2% 7% 85%
23%
80%
52%
90%
61%
27%
48%
31%
62%
90%
90%
21%
2% 33%
62%
65%
80%
75%
90%
14%
16%
90%
24%
90%
53%
64%
27%
2% 10%
90%
52%
0.4 2.2 0.4 0.5 2.1 0.8 1.5 1.3 0.3 0.3 0.8 54.4
0.7 0.5 0.4 0.2 0.4 0.2 1.3 1.8 0.2 0.7 0.2 1.1 0.3 0.7 14.8
2.8 2.4 1.5
0.5 3.1 0.5 0.7 2.9 1.1 2.0 1.8 0.4 0.5 1.2 75.4
0.9 0.7 0.5 0.3 0.6 0.3 1.9 2.5 0.3 1.0 0.2 1.5 0.4 0.9 20.5
3.8 3.4 2.1
$14
$12
$13
$10
$13
$9 $10
$10
$7 $9 $8 $6 $7 $6 $5 $8 $6 $5 $7 $6 $5 $6 $5 $5 $4 $4 $2 $1 $84
$25
$17
$15
$16
$13
$16
$12
$12
$13
$8 $11
$10
$8 $9 $8 $7 $10
$8 $7 $9 $8 $6 $7 $6 $6 $5 $5 $2 $1 $105
$31
$23
$20
$19
$17
$22
$16
$17
$18
$8 $13
$14
$11
$13
$11
$9 $13
$11
$7 $12
$10
$9 $10
$7 $9 $7 $7 $3 $1 $111
$72
$21
$19
$18
$18
$18
$15
$14
$14
$14
$13
$12
$11
$11
$11
$10
$10
$10
$9 $9 $9 $9 $9 $8 $8 $6 $6 $3 $2 $117
$36
$26
$24
$23
$23
$23
$19
$18
$17
$16
$17
$15
$14
$13
$13
$12
$12
$12
$12
$12
$11
$11
$11
$10
$10
$7 $7 $4 $2 $146
$45
$36
$33
$27
$31
$31
$26
$25
$24
$16
$20
$21
$19
$18
$18
$17
$17
$17
$13
$16
$15
$14
$15
$12
$14
$10
$10
$5 $3 $155
$103
5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 10%
10%
$1,18
4$2
68$7
36$9
03$5
19$6
81$5
19$2
81$5
39$6
03$1
,126
$169
$794
$577
$681
$897
$517
$603
$794
$530
$603
$794
$740
$229
$539
$519
$162
$95
$671
$1,26
5
HCPC
S Des
crip
tion
No.
HCPC
S
Savi
ngs
2011
($
mill
ion)
Aver
age
Annu
al
ASC S
hare
Ch
ange
20
08-2
011
Base
line:
20
11 AS
C Sh
are o
f Pr
oced
ures
Proj
ecte
d AS
C Sha
re
for 2
022
(2%
in
creas
e pe
r yea
r)
Proj
ecte
d AS
C Sha
re
for 2
022
(shar
e in
creas
e va
ries)
2011
Vo
lum
e of
Proc
e-du
res (
# pe
r 1,0
00
Med
icare
Be
ne-
ficiar
ies)
Proj
ecte
d Vo
lum
e of
Proc
e-du
res f
or
2022
(#
per 1
,000
M
edica
re
Bene
- fic
iaries
)*
A1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
A2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
A3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies Re
main
s Con
stant
B1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
B2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
B3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies In
creas
es By
3% pe
r Yea
r
% AS
C An
nual
Sh
are
Grow
th
Assu
mp-
tion f
or A
3 &
B3
Reim
burse
-m
ent
Diffe
renc
e Be
twee
n AS
Cs an
d HO
PDs
2011
M E D I C A R E C O S T S A V I N G S T I E D T O A M B U L A T O R Y S U R G E R Y C E N T E R S1 8
NO
TES:
*Inc
reasesvolum
epe
r1,000
Med
icarebe
neficiarie
sby
3%ann
ually.
**Th
erepo
rted
totalsareforsavings.The
remaining
colum
nsaresimplemeansacrossthe
120
procedu
res,forw
hich
themeanisnotinflu
enced
by (o
r wei
ghte
d fo
r) h
igh-
volu
me
proc
edur
es, s
uch
as c
atar
acts
. Sav
ings
are
repo
rted
in n
omin
al d
olla
rs. N
/A: n
ot a
pplic
able
.
91 92 93 94 95 96 97 98 99 100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
6704
252
332
6704
165
855
6790
031
255
6703
631
267
3014
067
108
4756
266
761
6704
052
204
2061
031
256
3127
664
640
6725
569
436
4533
068
815
4622
167
840
4533
167
210
6722
811
642
6448
051
700
Vit fo
r mac
ular h
oleCy
stosco
py an
d tre
atm
ent
Vit fo
r mac
ular p
ucke
rLa
ser s
urge
ry of
eye
Repa
ir bro
w de
fect
Rem
oval
of et
hmoid
sinu
sRe
mov
al of
inne
r eye
fluid
Endo
scopy
max
illary
sinu
sRe
sect
infer
ior tu
rbina
teRe
pair d
etac
hed r
etina
Lapa
rosco
pic ch
olecy
stecto
my
Revis
ion of
iris
Lase
r tre
atm
ent o
f ret
inaCy
stosco
py w
/biop
sy(s)
Drain
/injec
t join
t/bur
saEx
plora
tion m
axilla
ry si
nus
Sinus
endo
scopy
surg
ical
Injec
tion t
reat
men
t of n
erve
Reinf
orce
/gra
ft ey
e wall
Crea
te ea
rdru
m op
ening
Diag
nosti
c sigm
oidos
copy
Prob
e nas
olacri
mal
duct
Ligat
ion of
hem
orrh
oid(s)
Rem
ove e
yelid
lesio
nSig
moid
osco
py an
d biop
syTre
atm
ent o
f ret
inal le
sion
Treat
men
t of r
etina
l lesio
nEx
c fac
e-m
m m
alig+
mar
g 1.1-
2In
j fora
men
epidu
ral a
dd-o
nIrr
igatio
n of b
ladde
r
$13
$10
$9 $8 $8 $8 $6 $6 $6 $6 $5 $5 $5 $5 $4 $4 $4 $4 $3 $3 $2 $2 $2 $2 $1 $1 $1 $1 $1 $0.5
$2,3
07
7.78%
5.10%
7.36%
10.98
%7.2
3%11
.19%
10.53
%11
.09%
16.88
%11
.99%
11.18
%5.2
4%8.7
0%7.6
1%18
.62%
8.96%
22.38
%75
.05%
6.57%
11.68
%15
.64%
9.08%
59.92
%15
.10%
5.08%
10.61
%11
.58%
7.98%
17.51
%29
.91%
3.46
%
42%
13%
40%
22%
68%
39%
38%
37%
39%
34%
6% 27%
33%
19%
0.5%
37%
33%
13%
50%
40%
17%
51%
11%
8% 34%
7% 7% 3% 29%
3% 32%
53%
16%
50%
28%
85%
49%
47%
46%
48%
43%
7% 34%
41%
24%
1% 46%
41%
16%
63%
50%
21%
64%
14%
10%
43%
9% 9% 4% 36%
4% 40%
90%
36%
90%
63%
90%
90%
90%
90%
90%
90%
16%
78%
90%
55%
1% 90%
90%
36%
90%
90%
48%
90%
33%
24%
90%
21%
20%
10%
83%
10%
52%
0.7 2.6 0.5 4.0 0.4 0.6 0.4 0.5 0.5 0.4 1.8 2.2 0.3 0.8 153.1
0.3 0.4 1.8 0.3 0.3 1.3 0.2 1.7 1.4 0.7 2.9 2.3 3.5 0.8 4.0 5.62
0.9 3.6 0.6 5.6 0.6 0.8 0.5 0.7 0.7 0.5 2.5 3.1 0.4 1.1 212.0
0.4 0.5 2.4 0.3 0.5 1.7 0.3 2.4 2.0 0.9 4.0 3.2 4.9 1.0 5.5 7.78
$26
$15
$19
$18
$14
$17
$13
$11
$12
$11
$11
$11
$10
$9 $8 $7 $10
$6 $4 $6 $5 $4 $4 $4 $3 $3 $2 $2 $2 $1 $4,2
03
$32
$18
$24
$23
$18
$21
$16
$14
$15
$14
$14
$13
$12
$11
$10
$9 $12
$8 $6 $8 $6 $5 $5 $4 $3 $4 $3 $2 $2 $1 $5,2
31
$55
$42
$42
$52
$19
$38
$31
$26
$28
$29
$32
$31
$27
$25
$24
$18
$27
$18
$8 $14
$14
$6 $11
$10
$7 $9 $6 $4 $5 $3 $6,0
13
$36
$27
$24
$24
$24
$22
$18
$18
$16
$16
$16
$15
$13
$13
$12
$12
$11
$10
$9 $7 $7 $7 $6 $5 $4 $4 $3 $3 $3 $1 $6,6
04
$45
$34
$30
$30
$30
$28
$23
$22
$20
$20
$19
$19
$17
$16
$14
$14
$14
$13
$12
$9 $9 $9 $8 $6 $5 $5 $4 $4 $3 $2 $8,2
12
$77
$78
$54
$68
$32
$51
$43
$44
$37
$42
$44
$43
$36
$37
$33
$28
$31
$29
$17
$17
$20
$12
$18
$15
$11
$11
$8 $8 $8 $4 $9,3
83
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
N/A
$1,23
4$7
94$1
,234
$257
$801
$933
$1,23
4$9
33$7
73$1
,234
$1,44
2$2
37$1
,234
$794
$149
$933
$933
$437
$706
$522
$324
$603
$296
$422
$175
$169
$169
$226
$117
$99
$589
HCPC
S Des
crip
tion
No.
HCPC
S
Savi
ngs
2011
($
mill
ion)
Aver
age
Annu
al
ASC S
hare
Ch
ange
20
08-2
011
Base
line:
20
11 AS
C Sh
are o
f Pr
oced
ures
Proj
ecte
d AS
C Sha
re
for 2
022
(2%
in
creas
e pe
r yea
r)
Proj
ecte
d AS
C Sha
re
for 2
022
(shar
e in
creas
e va
ries)
2011
Vo
lum
e of
Proc
e-du
res (
# pe
r 1,0
00
Med
icare
Be
ne-
ficiar
ies)
Proj
ecte
d Vo
lum
e of
Proc
e-du
res f
or
2022
(#
per 1
,000
M
edica
re
Bene
- fic
iaries
)*
A1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
A2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
A3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies Re
main
s Con
stant
B1.
Base
line:
Sa
vings
fo
r 202
2 (A
SC sh
are
rem
ains
cons
tant
) ($
milli
on)
B2. S
avin
gs
for 2
022
(ASC
shar
e in
creas
es
2% pe
r ye
ar)
($m
illion
)
B3. S
avin
gs
for 2
022
(ASC
shar
e in
creas
e va
ries)
($m
illion
)
Volu
me p
er 1,
000 M
edica
re
Bene
ficiar
ies In
creas
es By
3% pe
r Yea
r
% AS
C An
nual
Sh
are
Grow
th
Assu
mp-
tion f
or A
3 &
B3
Reim
burse
-m
ent
Diffe
renc
e Be
twee
n AS
Cs an
d HO
PDs
2011
Tota
l or M
ean*
*
Medicare Cost Savings Tied to Ambulatory Surgery Centers
Produced with cost savings analysis from