Medicare Cost Savings Tied to Ambulatory Surgery Centers cost... · 2017. 3. 22. · ASCs, as this...

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

4

6

7

8

8

8

10

12

13

13

13

14

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 S4

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.

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 5

• $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.


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.


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


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.


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

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 0

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.

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 1

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


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


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.


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.


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

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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


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


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


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

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rosco

pic ch

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stecto

my

Revis

ion of

iris

Lase

r tre

atm

ent o

f ret

inaCy

stosco

py w

/biop

sy(s)

Drain

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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

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