Digital Debut

ASCA Survey Shows Limited Service of Medicaid Beneficiaries

The reimbursement rate, which is below the Medicare reimbursement rate, might be the primary barrier

BY ALEX TAIRA | MARCH 2023

In mid-February, ASCA conducted its first 60-Second Survey of 2023 and asked questions on payer mix, specifically ASCs’ current service levels of Medicaid beneficiaries. The 60-Second Survey is a bimonthly survey series introduced in spring 2021 that aims to take the pulse of the ASC community and help ASCA better serve its members and the ASC industry at large.

The Medicaid survey was open for 10 days and received 100 responses from ASCs in 36 different states. The median size of responding ASCs was four operating/procedure rooms, and 38 percent of respondents are single-specialty facilities. This survey was intended to support ASCA’s ongoing efforts on diversity, equity and inclusion (DEI), specifically a DEI working group discussion expanding community access to ASCs.

Survey Results

When asked to estimate percentages of patients covered by categories of payer, most ASCs responded that the largest category of payer is commercial insurance. The median response for percentage of patients covered by commercial insurance was 45 percent of patients. Medicare/Medicare Advantage (MA) was the next most common payer, with a median response of 35 percent of patients. This will be something to watch, as MA has been growing relative to traditional, fee-for-service (FFS) Medicare. According to an enrollment analysis by the Kaiser Family Foundation, MA plans will cover a majority of Medicare beneficiaries for the first time in 2023. Medicaid and self-pay were by far the least common payers reported, covering a median response of 5 percent and 2 percent of patients in surveyed facilities, respectively. ASC respondents that are solely physician owned attested to seeing slightly fewer commercial patients—40 percent—and slightly more Medicare/MA patients—45 percent. There was no significant difference in payer mix between single- and multispecialty ASCs.

Overall, 59 percent of respondents see pediatric patients, but facilities that are solely physician owned are much less likely to see pediatric patients, 43 percent only. On the other hand, 82 percent of ASCs with some level of hospital ownership attested to seeing pediatric patients. A recent thread on ASCA Connect, the ASCA members discussion community, asked about the most common pediatric surgery procedures, and ASCA members cited ophthalmology, GI and urology, among others.

With regards to treatment of Medicaid patients specifically, 76 percent of survey respondents said that Medicaid reimbursement is substantially below Medicare reimbursement. Just 8 percent of facilities, or eight ASCs, responded that Medicaid reimbursement is equal to or greater than Medicare reimbursement, and each of those eight facilities came from a different state. Unsurprisingly, those facilities reported doing more Medicaid-covered procedures—a median of 18 percent—than the total survey average—a median of 5 percent. Overall, 58 percent of respondents said that Medicaid patients present additional treatment challenges, such as a lack of reliable transportation and postoperative support. However, almost one-third of respondents, 32 percent, said that Medicaid patients are not any more challenging than other patients. This could lead to the conclusion that reimbursement rate, and not patient health status, is the primary barrier to ASCs performing more care for patients covered by Medicaid.

Write Alex Taira with questions about this survey or to propose topics for future surveys. For more information on ASCA’s DEI initiative, write David Opong-Wadee.