ASC Advocates Return to Capitol Hill during National Advocacy Day

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ASC Advocates Return to Capitol Hill during National Advocacy Day

Participants represented 31 states and met with more than 100 members of Congress and their staff

Linda Bedwell, RN, CASC

Linda Bedwell, RN, CASC


Linda Bedwell, RN, CASC, director of Powder River Surgery Center in Gillette, Wyoming, recently participated in ASCA’s first National Advocacy Day in more than three years. From February 27 to March 1, 70 participants representing 31 states met with 102 members of Congress and their staff. Bedwell received a National Advocacy Day Scholarship, which helped offset the rising cost of travel to attend the event. Below is an excerpt from an interview.

Q: This was your first time attending National Advocacy Day. What made you decide to come to Washington, DC, to advocate for the ASC community?

Linda Bedwell (LB): Having been in the ASC industry for over 20 years, I have watched many changes, and not for the better, regarding the Centers for Medicare & Medicaid Services (CMS) reimbursement rates. Complaining to my center staff, physicians and peers was doing very little good, so I decided to put my words where my mouth was and get out and see if a director from a small, independent ASC could make a difference. Doing nothing clearly was not helping the situation at all.

Q: You met with several congresspeople, including Senator John Barrasso, MD (R-WY). What did you discuss in your meetings?

LB: Meeting Senator Barrasso was an incredible opportunity. We discussed healthcare in Wyoming, including the importance of accreditation for ASCs. We achieved Accreditation Association for Ambulatory Health Care (AAAHC) accreditation in March 2021; only five out of 20 ASCs in Wyoming are accredited. Receiving recognition from Blue Cross Blue Shield of Wyoming last year as a designated Blue Circle of Excellence Center for our knee and hip replacement program was an honor and a privilege. We are currently waiting for a survey from AAAHC for the Advanced Orthopaedic Certification.

Achieving accreditations and certifications is our core initiative to show our commitment to quality to patients and payers. With a mission to keep healthcare costs low in Wyoming, we need to find ways to maintain and grow our services for the people of our great state and get the word out about how talented and committed our surgeons and healthcare providers are here. Wyomingites deserve excellent healthcare with high-quality options.

For the state of Wyoming, we discussed just how sparsely populated we are. With less than 1,500 hospital beds in the state and only 20 surgery centers, [we discussed] what the challenges are with such low volume in an industry that is volume-dependent, and how all healthcare providers are affected. With government plans, Medicare sets the benchmark for assessing fees for government payers (US Department of Veterans Affairs, TRICARE, Medicaid, etc.) and some commercial payers are also moving to a percentage of Medicare rates. The CMS fee schedule affects almost every payer in Wyoming. We noted that some hospitals, both critical access and non-critical access, are in trouble and are reporting the need to cut service lines. Hospitals are struggling to support registered nurses (RN) and clinical staff salaries that are equitable and offer patients top-quality healthcare within our state. It is common for healthcare providers to have an insurance case mix of +/- 60 percent government and +/- 40 percent commercial payers across the country. However, combined with low volume, the impact is palpable for both hospitals and ASCs as we try to provide services to all constituents of our state. Big kudos to Wyoming legislators for recognizing and addressing workers’ compensation, which just received a justifiable increase in reimbursement. Hopefully, Medicaid will be addressed next.

We also discussed that CMS is calculating reimbursement on the most recent pre-COVID-19 pandemic hospital wage index survey updated in 2019 and the effects on all healthcare providers. All healthcare workers have had to adjust clinical salaries to maintain and attempt to recruit RNs and other clinical providers since then. Supply chain and general operating costs have also increased, making profit and loss reports look completely different pre- and post-pandemic.

Q: How would enacting the Outpatient Surgery Quality and Access Act of 2023 (H.R. 972/S. 312) improve your facility’s ability to provide care?

LB: Moving toward equitable payments between hospital outpatient department (HOPD) and ASC reimbursement only makes sense. Giving the option for Medicare recipients to choose their place of service for a surgical procedure should not be based on the 20 percent patient responsibility cost to the patient. HOPDs have a capped patient responsibility ($1,600 in 2023) that ASCs do not, which especially impacts high-cost, implant-intensive type procedures, such as total joint procedures. It is a fact that lower-income recipients commonly do not have secondary insurance coverage for the 20 percent patient responsibility. Secondary insurance coverage also comes with an additional patient financial impact. These patients are driven financially to an HOPD, which costs CMS thousands more for the same procedure, but the patient’s responsibility will be less. Extending the same patient responsibility cap to the ASC setting will provide greater access to the ASC setting for the Medicare beneficiaries who need it most.

Write Maia Kunkel, ASCA’s Government Affairs manager, with questions.