[Congressional Record Volume 147, Number 28 (Tuesday, March 6, 2001)]
[Extensions of Remarks]
[Page E287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    IF MEDICARE CAN BUY A PROSTATE BIOPSY FOR $178, WHY SPEND $506?

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, March 6, 2001

  Mr. STARK. Mr. Speaker, Medicare pays different amounts for various 
medical procedures, depending on where the service is performed. In 
general (but not always), we pay more for a procedure in a hospital 
outpatient department, less for the same procedure in an ambulatory 
surgical center, and often even less when that procedure is performed 
in a doctor's personal office.
  Some people--the very frail or those who are quite sick--often need 
to be cared for in a setting where intensive support services can be 
quickly provided. But for most, these various procedures can be 
performed safely in a variety of settings.
  For those who do not need back-up support, it would seem that 
Medicare ought to pay no more than the lowest cost site of service. 
I've introduced legislation to ensure that type of savings--savings 
that would run into the hundreds of millions per year.
  The following letter from a group of doctors describes why we should 
enact this change--ASAP.

                                                February 14, 2001.
     Representative Pete Stark,
     Cannon House Office Building,
     Washington, DC.
       Dear Representative Stark: We are a group of six 
     urologists. We are writing this letter to voice our concerns 
     about, and ask for your help in clarifying/rectifying HCFA 
     reimbursement policy as it relates to site of service 
     payments.
       To briefly summarize, three routine and frequently 
     performed urology procedures are reimbursed at very different 
     rates when performed in a physician's office versus an 
     ambulatory surgical center. The procedures, corresponding CPT 
     codes and associated payments are:

------------------------------------------------------------------------
                                                         Office    ASC
               CPT code and description                   pmt.     pmt.
------------------------------------------------------------------------
52000  Cystourethroscopy..............................     $179     $418
52281  Cystourethrscopy w/urethral calibration/             232      569
 dilation.............................................
55700  Prostate biopsy................................      178      506
------------------------------------------------------------------------

       As you can see, if the bill for these procedures is sent to 
     Part A Medicare instead of Part B Medicare the reimbursement 
     is tremendously higher. This is true even though they are 
     exactly the same service provided with identical equipment.
       The Medicare Payment Advisory Commission (MedPAC) has 
     stated ``All else being equal, Medicare should pay for 
     ambulatory care based on the service, not the setting in 
     which it is provided.'' AUA Health Policy Brief, Page 5, 
     December 1998). The major cost drivers of providing these 
     services are basically identical regardless of site of 
     service (cost of cystoscopes, ultrasound imaging equipment, 
     power tables, sterilization equipment, light sources, 
     irrigation fluid, ancillary personnel, and cost per square 
     foot of space). We believe this present policy adversely and 
     unfairly affects all providers who aren't owners of an ASC as 
     well as Medicare beneficiaries.
       Medicare beneficiaries are concerned about access and 
     quality of care. Presently we provide these services at four 
     locations. Without a level reimbursement policy concerning 
     site of service, we will have to consider closing some 
     offices and congregating all or most of these procedures at 
     one centrally located ASC.

     

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