[Congressional Record Volume 146, Number 71 (Friday, June 9, 2000)]
[Extensions of Remarks]
[Page E959]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      A WAY TO SAVE MEDICARE, BENEFICIARIES AND TAXPAYERS BILLIONS

                                 ______
                                 

                        HON. FORTNEY PETE STAARK

                             of california

                    in the house of representatives

                          Friday, June 9, 2000

  Mr. STARK. Mr. Speaker, even in an era of unprecedented budget 
surpluses, wasting Medicare dollars is unacceptable.
  The same procedures, carried out in a physician's office, an 
ambulatory surgical center or in a hospital outpatient department are 
reimbursed at widely different rates. These differences exist across 
medical specialties and do not consistently relate to the setting in 
which the service is provided and may vary up to 179%. (Table 1).
  The disparity in payments for equivalent services, regardless of 
setting, needs to be eliminated and payments reduced to the lowest 
levels.
  Mr. Speaker, there is simply no reason in the world for us to pay 
$1001 for glaucoma surgery in a hospital outpatient setting, when we 
can provide the same service for $415 in an ambulatory surgical center.
  The taxpayers, beneficiaries and Medicare can save billions of 
dollars in the years to come if we simply pay at the lowest of the 
hospital outpatient, ambulatory surgical center or doctor's office 
rate. We should pay at the lowest rate a service can be safely 
provided, regardless of setting. I have proposed this in H.R. 2115, and 
I urge the Members to consider this legislation as a way both save 
money and help beneficiaries.


 TABLE 1.--COMPARISON OF PAYMENT RATES ACROSS SETTINGS FOR SELECTED HIGH VOLUME AMBULATORY CARE SERVICES, 2000.
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                                                                                                        Practice
             Type of service                 Code            Description          ASC rate   OPD rate   expense
                                                                                                          rate
----------------------------------------------------------------------------------------------------------------
Gastroenterology........................      45380  Colonoscopy and biopsy....       $425       $387       $260
                                              45378  Diagnostic colonoscopy....        425        387        192
Ophthalmology...........................      66170  Glaucoma surgery..........        415       1001  .........
                                              68720  Create tear sac drain.....        491       1149  .........
Orthopedics.............................      23420  Repair of shoulder........       1110       1753  .........
                                              29880  Knee arthroscopy/surgery..        680       1191  .........
Otolaryngology..........................      30520  Repair nasal septum.......        537       1232  .........
                                              69436  Create ear drum opening...        233        583  .........
Dermatology/Reconstructive Surgery......      19120  Removal breast lesion.....        411        623  .........
                                              13131  Repair of wound or lesion.        383        181  .........
Diagnostic..............................      93880  Duplex scan, extracranial         132  .........        150
                                                      arteries.
                                              93307  Echo exam of heart........        213  .........        171
Radiology...............................      70450  CAT scan of brain/head....        237  .........       188
----------------------------------------------------------------------------------------------------------------
Source: Federal Register 1999, Federal Register 2000a, Federal Register 2000b.
Note: OPD (outpatient department), ASC (ambulatory surgical center), Practice Expense Rate (physician's office),
  CAT (computerized axial tomography).


  

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