Manchikanti Laxmaiah, Boswell Mark V
Pain Management Center of Paducah, KY 42003, USA.
Pain Physician. 2007 Sep;10(5):627-50.
There has been an explosive increase in procedures performed in surgery centers, with approximately 4,700 Medicare-certified surgery centers in the United States. Total ambulatory surgical center (ASC) payments have increased substantially: $1 billion in 1996, and $2.9 billion in 2006. In June 1998, the Healthcare Financing Administration (HCFA; CMS), proposed an ASC rule in which at least 60% of interventional procedures were eliminated from ASCs and the remaining 40% faced substantial cuts in payments. Following the publication of this rule, based on public comments and demand, Congress intervened and delayed implementation of the rule for several years. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) granted broad statutory authority to the Secretary of Health and Human Services to design a new ASC payment system based on the hospital outpatient payment system. The Centers for Medicare and Medicaid (CMS) published its proposed outpatient prospective system for ASCs in 2006, setting ASC payments at 62% of HOPD payments. This rule faced substantial opposition from providers, patients, and Congress. Consequently, CMS revised the rule with a 4-year transition formula to provide ASCs with 65% of HOPD payments. Based on the new proposed rule, most interventional pain management procedures in ASCs will lose approximately 3% to 5% without taking into account that there have not been any increments since 2004, except for a few small increases for some procedures, along with the addition of office procedures, which can now be performed in an ASC setting. However, payments for procedures moved from the office setting to ASCs remain at the lower office rates, which face substantial cuts on their own. The proposed CMS rule will have widespread effects on physician payments, ASC payments, and particularly interventional pain management physicians.
手术中心进行的手术数量呈爆发式增长，美国约有4700家获得医疗保险认证的手术中心。门诊手术中心（ASC）的总支付额大幅增加：1996年为10亿美元，2006年为29亿美元。1998年6月，医疗保健财务管理局（HCFA；现为医疗保险和医疗补助服务中心（CMS））提出了一项ASC规则，据此ASC中至少60%的介入性手术被取消，其余40%的手术支付大幅削减。该规则发布后，基于公众意见和需求，国会进行了干预并将该规则的实施推迟了数年。2003年的《医疗保险处方药、改进和现代化法案》（MMA）赋予了卫生与公众服务部部长广泛的法定权力，以设计一种基于医院门诊支付系统的新的ASC支付系统。医疗保险和医疗补助服务中心（CMS）于2006年公布了其针对ASC的拟议门诊前瞻性系统，将ASC支付设定为医院门诊支付率的62%。该规则遭到了提供者、患者和国会的强烈反对。因此，CMS用一个为期4年的过渡公式修订了该规则，为ASC提供医院门诊支付率65%的费用。根据新的拟议规则，ASC中大多数介入性疼痛管理手术将损失约3%至5%，这还未考虑到自2004年以来没有任何增加，除了一些手术有少量增加，以及新增了可在ASC环境中进行的办公室手术。然而，从办公室环境转移到ASC的手术支付仍维持较低的办公室费率，而这些费率本身也面临大幅削减。CMS的拟议规则将对医生支付、ASC支付，尤其是介入性疼痛管理医生产生广泛影响。
