Ambulatory Surgical Centers Stakeholder Meeting May 27, 2010

Bryce Docherty for the CA Ambulatory Surgery Association (CASA): CASA represents over 200 ASCs ranging from single and multi-specialty to physician-owned to joint ventures between hospitals and physicians. These centers range from the very small to the very large and are located throughout California. Methodology: The Capen decision forced many centers to no longer be state licensed. Concerned data does not include all ASCs. Population in workers’ compensation different than Medicare. At least half of California WC cases are orthopedic. Only 7% in Medicare ASCs are orthopedic. Need to be paid same rate as outpatient hospitals. ASCs procedures will move to outpatient or inpatient hospitals. Adopting 120% of ASC rate would reduce fees by 40-50%. There will be no savings if procedures all go to hospital outpatient departments and costs will increase when cases go to the inpatient hospital setting. Existing law [Labor Code Section 5307.1(f)] stipulates that within the authority granted to the Administrative Director in augmenting certain elements of the OMFS that rates or fees established pursuant to that authority shall be adequate to ensure a “reasonable standard of service and care for injured employees.” CASA would argue that reducing fees by 40-50 percent to ASCs for outpatient surgery in workers’ compensation by adopting a rate of 120 percent of the ASC Medicare fee schedule unequivocally will violate said access mandate adopted by the California Legislature in 2003. Most recently, the DWC released an annual access to care study as mandated by existing law [Labor Code Section 5307.2] for calendar year 2008. The University of Washington, whom the DWC contracted to perform the study, found that over one-third of providers reported that they intend to decrease their workers’ compensation volume or quit treating injured workers all together. It was also reported in the same study that nearly half or 47 percent of injured workers reported experiencing one or more access barriers at some point during their treatment. Therefore, CASA would agree with the conclusions made by the University of Washington regarding injured workers’ access to quality care is not adequate and improvements are desperately needed to ensure the needed outpatient surgery that injured workers deserve and ASCs are ready and able to provide. Unfortunately, reducing fees to ASCs by 40-50 percent does not successfully accomplish that objective.