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Average facility fee payments to ambulatory surgery centers (ASCs) have declined 26% per episode and 28% per procedure since fee schedule changes mandated by SB 863 were adopted last year according to a new study by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) and the California Workers’ Compensation Institute (CWCI). The results of this study are consistent with the WCIRB’s initial projection of a 25% reduction in ASC costs that was part of the January 1, 2013 Pure Premium Rate Filing.

The CWCI/WCIRB joint study measured average amounts billed and paid for workers’ compensation outpatient surgery services rendered in the year preceding the adoption of the revised fee schedule (2012) and in the first 6 months after the revised fee schedule took effect (January through June of 2013). Payment results were measured both on a per procedure basis using CWCI data, and a per episode basis using WCIRB data. In addition, the authors looked for changes in a number of factors that can affect the total amounts paid to ASCs. Among the findings of the report are:

  • The average amount paid per ASC procedure following the implementation of the revised ASC fee schedule declined 28%.
  • The average amount paid for ASC services per episode declined 26%.
  • Although billings increased and negotiated discounts eroded, the net paid amounts for ASC services were not materially affected.
  • Both ASCs and hospital outpatient departments showed declines in the proportion of outpatient facility fees paying for additional services associated with the primary paid procedure.
  • The proportion of ASC payments attributable to services not subject to the fee schedule change increased, but remained relatively small.
  • The data indicate no change in the mix of services or the percentage of episodes occurring in outpatient hospital settings and ASCs.

The study authors note that their findings are preliminary, so the WCIRB and CWCI will continue to monitor ASC experience and plan to update the report later in 2014 to reflect all 2013 data. The joint study may be viewed, printed or downloaded from the Research section of the Institute’s website