ASC patients with Medicare coverage now can use a simple tool to compare total costs and what they will pay for procedures and surgeries in ASCs and hospital outpatient departments.
CMS launched the online procedure price lookup tool on Nov. 27, 2018. The tool was a requirement of the comprehensive 21st Century Cures Act that President Obama signed into law in December 2016.
CMS Administrator Seema Verma noted in a blog post that healthcare spending accounts for one out of every five dollars spent in the United States. Further, she pointed out that patients are shouldering the costs through deductibles and copays. Verma wrote that the procedure price lookup tool provides national averages for the amount Medicare pays a hospital or ASC and the national average copayment of Medicare beneficiaries with no Medicare supplemental insurance. (Editor’s Note: Read much more from Administrator Verma on this issue at: .)
The Ambulatory Surgery Center Association (ASCA) supported the 21st Century Cures Act and the price comparison tool. “ASCA commends the growing recognition in the U.S. Congress of the value that ASCs provide,” says ASCA Director of Government Affairs Heather Falen Ashby. “We commend the passage of the legislation that created the procedure price lookup tool.”
The lookup tool’s main page asks consumers to enter the name or procedure number of their anticipated surgery. It provides a dropdown list of options if they put in a single word, such as colonoscopy. After selecting an option, the tool displays costs in two columns, one for ASCs and one for hospital outpatient departments (HOPDs).
For example, if a patient selected the procedure titled, “Cancer screening of the colon (large bowel) using an endoscope (colonoscopy) for individuals who are not high risk,” the tool displays:
- For ASCs: Average Medicare pays — $370;
- For HOPDs: Average Medicare pays — $710;
- Patient pays (average): $0.
In another example, for the procedure titled, “Removal or shaving of hip joint socket cartilage using an endoscope,” the tool displays:
- For ASCs: Average Medicare pays — $2,177 and average total cost — $2,721;
- For HOPDs: Average Medicare pays — $4,485 and average total cost — $5,606;
- Patient pays (average) for ASCs: $544;
- Patient pays (average) for HOPDs: $1,121.
“Although it is still a very new resource, ASCA is pleased that the procedure lookup tool is easy to use and intuitive for patients,” Ashby says. “This is a significant step toward transparency, but is limited in providing only national average amounts. Actual copays will vary based on a patient’s geographic location.” (Editor’s Note: Readers can interact with the new tool by visiting: .)
ASCs might refer Medicare patients to the tool for an idea of the cost difference between the two surgical settings. “Patients benefit when they know their out-of-pocket costs up front,” Ashby says.