The Workers’ Compensation Research Institute released a study focusing on how facility payments to ambulatory surgery centers (ASCs) for surgeries in Georgia changed after the state changed their medical fee schedule in 2014.

Georgia changed their ASC and hospital outpatient fee schedule starting May 1, 2014, to follow Medicare’s Hospital Outpatient Prospective Payment System (OPPS) ambulatory payment classification. This set ASC fee schedule rates at 2.25 times the Medicare OPPOS rates that apply to hospital outpatient departments.

Other studies have shown that average facility payments increased faster in Georgia than in other states in 2014, but beyond that there has not been much research on the topic.

To understand the result of these changes researchers looked at payments made to ASCs and hospital outpatient departments in the state for surgeries taking place through March 2017. They used data on the most common surgeries that are used to treat knee and shoulder conditions for injured workers’. Additional changes to Georgia’s fee schedule made in 2018 were not part of the data used.

They found that because of the changes, average facility payments for knee surgeries did not change much though the price was different depending on the type of knee surgeries. While common knee surgeries did not see a significant payment change, there was a 32 percent increase for certain knee surgeries which may reflect fee schedule changes. They also found that average ASC payments for shoulder surgeries increased across most shoulder surgery types which could reflect different fee schedule rates that applied to different procedures. After the changes in 2014, average payments to facilities for shoulder surgeries in ASCs were higher than the average payments for similar surgeries in hospital outpatient settings.

Georgia’s ASC fee schedule rates for knee and shoulder arthroscopies were 3.6 to 4.2 times the rates Medicare typically pays for similar surgeries in ASC settings. Hospital outpatient facility fee schedules for common knee and shoulder arthroscopies were 1.8 to 2.4 times the rates that Medicare pays for similar services in hospital outpatient settings.

Read more from WorkCompWire and purchase the study from WCRI here.