Repricing specialty hospital outpatient services using ambulatory surgery center prices
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 orth...
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| Veröffentlicht in: | Health care financing review 2007-12, Vol.29 (2), p.81-90 |
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| creator | Healy, Deborah Cromwell, Jerry Thomas, Frederick G |
| description | 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. |
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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.</description><identifier>ISSN: 0195-8631</identifier><identifier>EISSN: 1554-9887</identifier><identifier>PMID: 18435225</identifier><language>eng</language><publisher>United States: Superintendent of Documents</publisher><subject>Also Featuring ; Ambulatory care ; Beneficiaries ; Codes ; Comparative analysis ; Drugs ; Fees and Charges ; Health administration ; Hospitals ; Insurance Claim Reporting ; Laboratories ; Laws, regulations and rules ; Medical care, Cost of ; Medical referrals ; Medical research ; Medicare ; Medicine, Experimental ; Orthopedic equipment and supplies ; Orthopedics ; Outpatient care facilities ; Outpatient Clinics, Hospital - economics ; Physicians ; Prescribing ; Price variance ; Prices ; Prices and rates ; Prospective payment systems ; Prospective payment systems (Medical care) ; Reimbursement ; Reimbursement Mechanisms ; Software ; Studies ; Surgery ; Surgical clinics ; Surgicenters ; United States</subject><ispartof>Health care financing review, 2007-12, Vol.29 (2), p.81-90</ispartof><rights>COPYRIGHT 2007 Superintendent of Documents</rights><rights>Copyright Superintendent of Documents Winter 2007/2008</rights><rights>2007</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195025/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195025/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18435225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Healy, Deborah</creatorcontrib><creatorcontrib>Cromwell, Jerry</creatorcontrib><creatorcontrib>Thomas, Frederick G</creatorcontrib><title>Repricing specialty hospital outpatient services using ambulatory surgery center prices</title><title>Health care financing review</title><addtitle>Health Care Financ Rev</addtitle><description>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.</description><subject>Also Featuring</subject><subject>Ambulatory care</subject><subject>Beneficiaries</subject><subject>Codes</subject><subject>Comparative analysis</subject><subject>Drugs</subject><subject>Fees and Charges</subject><subject>Health administration</subject><subject>Hospitals</subject><subject>Insurance Claim Reporting</subject><subject>Laboratories</subject><subject>Laws, regulations and rules</subject><subject>Medical care, Cost of</subject><subject>Medical referrals</subject><subject>Medical research</subject><subject>Medicare</subject><subject>Medicine, Experimental</subject><subject>Orthopedic equipment and supplies</subject><subject>Orthopedics</subject><subject>Outpatient care facilities</subject><subject>Outpatient Clinics, Hospital - economics</subject><subject>Physicians</subject><subject>Prescribing</subject><subject>Price variance</subject><subject>Prices</subject><subject>Prices and rates</subject><subject>Prospective payment systems</subject><subject>Prospective payment systems (Medical care)</subject><subject>Reimbursement</subject><subject>Reimbursement Mechanisms</subject><subject>Software</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical clinics</subject><subject>Surgicenters</subject><subject>United 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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.</abstract><cop>United States</cop><pub>Superintendent of Documents</pub><pmid>18435225</pmid><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; PubMed Central Open Access; EBSCOhost Business Source Complete; U.S. Government Documents; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Also Featuring Ambulatory care Beneficiaries Codes Comparative analysis Drugs Fees and Charges Health administration Hospitals Insurance Claim Reporting Laboratories Laws, regulations and rules Medical care, Cost of Medical referrals Medical research Medicare Medicine, Experimental Orthopedic equipment and supplies Orthopedics Outpatient care facilities Outpatient Clinics, Hospital - economics Physicians Prescribing Price variance Prices Prices and rates Prospective payment systems Prospective payment systems (Medical care) Reimbursement Reimbursement Mechanisms Software Studies Surgery Surgical clinics Surgicenters United States |
| title | Repricing specialty hospital outpatient services using ambulatory surgery center prices |
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