全球智库信息集成服务系统

Common Outpatient Workers' Compensation Procedures Should Be Done in Hospitals

• Most ambulatory surgical centers eligible for a California Official Medical Fee Schedule facility fee, or alternatively, a particular class of ASCs, are generally equipped to provide services to the workers' compensation population that do not require a one-night stay.
• Some such procedures may be more appropriately performed as a hospital outpatient procedure than as an ASC procedure because hospitals have the ready availability of emergency and observation services for overnight stays that go beyond ASC services.

Cervical Spinal Fusions Might Be Added to ASC Fee Schedule, with Candidate Criteria

• Data analyses and literature review did not provide strong support for adding any procedures to the ASC fee schedule with the possible exception of procedures related to cervical spinal fusions.
• While the literature suggests that two-level anterior cervical fusions and the use of instrumentation for one- or two-level fusions can be performed safely on an outpatient basis, it lacks evidence-based selection criteria to suggest which patients are candidates for the procedures in an outpatient setting.

A Fee Schedule Allowance for Inpatient ASC Procedures Cannot Now Be Set

• Data are not readily available to establish an appropriate fee schedule allowance for "inpatient only" procedures in an ASC setting.
• A single multiplier applied to the inpatient rate is not suitable for the full range of common inpatient procedures because of differences in the average costs for the average inpatient relative to the average cost for patients most likely to be candidates for ambulatory surgery.

The California Department of Industrial Relations asked RAND to examine the feasibility and appropriateness of including procedures that are typically performed only in an inpatient setting on the workers' compensation Official Medical Fee Schedule for ambulatory surgical center facility fees. The authors used interviews, literature review, and data analysis to assemble information on the requirements applicable to ASCs, assess how the criteria that Medicare uses to assess whether procedures can be safely performed in an outpatient setting apply to the workers' compensation patient population, and to examine alternative methods for establishing fee schedule amounts. The study focused on 23 high-volume workers' compensation inpatient procedures with relatively short average lengths of stay. The report finds that most ASCs that are currently eligible for facility fees are equipped to provide services that do not require a one-night stay. However, the data analyses and literature review did not provide strong support for adding any procedures to the fee schedule with the possible exception of procedures related to cervical spinal fusions. Other than instrumentation used in conjunction with spinal fusions, relatively few of the study procedures are being performed in an ambulatory setting on either WC or privately insured patients ages 18–64. The literature suggests that two-level anterior cervical fusions and the use of instrumentation for one- or two-level fusions can be performed safely on an outpatient basis but does not include evidenced-based selection criteria to suggest which patients are appropriate candidates for having the procedures in an outpatient setting.

• Chapter One

  Introduction

• Chapter Two

  Overview of ASC Regulatory Framework and Facilities

• Chapter Three

  Coverage Policies for Surgeries Performed in ASCs

• Chapter Four

  Analyses Using Administrative Data

• Chapter Five

  Evidence from the Literature

• Chapter Six

  Payment Policies for "Inpatient Only" Procedures

• Chapter Seven

  Discussion of Findings and Recommendations