Carey Kathleen
Kathleen Carey (
Health Aff (Millwood). 2015 Oct;34(10):1738-44. doi: 10.1377/hlthaff.2015.0252.
Ambulatory surgery centers (ASCs) are freestanding facilities that provide services to patients who do not require an overnight stay. The number of ASCs has grown rapidly over the past fifteen years, as have the number of surgical procedures performed at them. ASCs now compete with hospital outpatient departments. This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid. For six common outpatient surgical procedures, prices paid to ASCs on the whole grew in line with general medical care prices, while overall prices paid to hospital outpatient departments for the same procedures climbed sharply. This provides no evidence that ASCs are successfully pressuring hospital outpatient departments to lower their prices. Not unexpectedly, private insurers paid ASCs considerably more than Medicare paid ASCs for the same procedures. Medicare currently pays ASCs a legislated percentage of what it pays hospital outpatient departments for the same services, but there is a considerable discrepancy between this ratio and the ratio of payments by private insurers across provider types and procedures. This finding questions the wisdom of using a single ratio for ASC payments to hospital outpatient department payments.
门诊手术中心（ASC）是独立的设施，为不需要过夜住院的患者提供服务。在过去十五年中，门诊手术中心的数量增长迅速，在这些中心进行的外科手术数量也同样增长迅速。门诊手术中心现在与医院门诊部展开竞争。本研究通过使用一个大型的全国索赔数据库来考察门诊手术中心增长的收入方面，该数据库包含实际支付价格的信息。对于六种常见的门诊外科手术，总体而言，支付给门诊手术中心的价格与一般医疗护理价格同步增长，而医院门诊部针对相同手术的总体支付价格则大幅攀升。这没有提供证据表明门诊手术中心成功地迫使医院门诊部降低其价格。不出所料，对于相同的手术，私人保险公司支付给门诊手术中心的费用比医疗保险支付的要多得多。医疗保险目前按照其支付给医院门诊部相同服务费用的法定百分比支付给门诊手术中心，但在这一比率与不同提供者类型和手术的私人保险公司支付比率之间存在相当大的差异。这一发现质疑了使用单一比率来确定门诊手术中心与医院门诊部支付比例的合理性。
