Prostate surgery reimbursement rises

Some other surgeries are hurt by new APCs

Critics of the proposed ambulatory payment classifications (APCs) suggest the Health Care Financing Administration (HCFA) could have updated the APC proposal and allowed for new technologies.

HCFA did update data for three new procedures for men with prostate problems. For example, one of those procedures is currently reimbursed at $595 and listed under CPT code 52601: transurethral electrosurgical resection of the prostate, including control of postoperative bleeding, complete. The proposed APC code of 524 defines it as a level IV cystourethroscopy and other genitourinary procedures, with a reimbursement payment of $1,131, a $536 increase.

However, HCFA’s proposed APCs likely will have a negative effect on many more surgical procedures, two surgery center executives say. The proposed APCs may harm ophthalmology surgery centers because of large decreases in reimbursement for cataract and other procedures, says Mark Mayo, executive director of the Illinois Freestanding Surgery Center Association and director of Valley Ambulatory Surgery Center in St. Charles, IL.

Ken McDonald, president and chief executive officer of AmSurg Corp. of Nashville, TN, says two of the field’s most affected specialties are gastroenterology and ophthalmology. AmSurg is a publicly traded outpatient surgery center company that specializes in single-specialty surgery centers.

The solution to all reimbursement problems with APCs would be for HCFA to make changes in its methodology, McDonald says. "The real key is to see if we can get HCFA to work with the industry to come up with viable methodology to use correct data in making the right change."


How to Access HCFA’s Proposal

For a copy of the Sept. 8, 1998, Federal Register containing the Medicare Program; Prospective Payment System for Hospital Outpatient Services; Proposed Rules, and the June 12, 1998, Federal Register containing the Medicare Program: Update of Ratesetting Methodology, Payment Rates, Payment Policies and the List of Covered Surgical Procedures for Ambulatory Surgical Center Effective Oct. 1, 1998, send your request to:

New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order for $8, payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders also may be made by telephone to (202) 512-1800 or by faxing to (202) 512-2250.

The Federal Register is available for viewing at many libraries or in an on-line database through GPO Access, a service of the U.S. Government Printing Office. Internet users may access the data base by using the Web: http://www.access.gpo.gov/su_docs/.

Sources

For more on how the proposed APCs will affect Medicare patients, contact:

Kathryn Barry, Senior Director, Health Policy and Reimbursement, United States Surgical Corp., 150 Glover Ave., Norwalk, CT 06856. Phone: (203) 845-1985. Fax: (203) 845-4317. E-mail: kathryn.barry@ussurg.com. Web: http://www.ussurg.com.

Beth A. Boyd, RN, Clinical Director, Educational Coor dinator, The Breast Center, 702 Canton Road, Marie tta, GA 30060. Phone: (770) 428-4486, ext. 203. Fax: (770) 425-6008. E-mail: bethtbc@mindspring.com.

Maxine Brinkman, MHA, Director of Women’s Health Services, Mercy Health Network, 1000 Fourth St. SW, Mason City, IA 50401. Phone: (515) 424-7347. Fax: (515) 422-6383. E-mail: brinkman@mercyhealth.com.

Tracie Holyfield, Product Line Specialist for Women’s Services, Moses Cones Health System, 1200 N. Elm St., Greensboro, NC 27401-1020. Phone: (336) 832-6516. Fax: (336) 832-7979. E-mail: tracie.holyfield@mosescone.com.

Jerry Henderson, Executive Director, SurgiCenter of Baltimore, 23 Crossroads Drive, Owings Mills, MD 21117. Phone: (410) 356-0300. Fax: (410) 356-7505. E-mail: surgicen@erols.com.