# Understanding the Outpatient Surgery Quality and Access Act of 2021

This bill makes changes to how Medicare pays for surgeries performed at ambulatory surgical centers—these are standalone facilities where patients have surgery and go home the same day, rather than staying overnight in a hospital. The main goal is to make the payment system fairer and more transparent for these centers and to give patients better information when choosing where to have their surgery.

Right now, ambulatory surgical centers and hospital outpatient departments often perform the same procedures but get paid differently by Medicare. This bill tries to level the playing field by making sure ambulatory surgical centers get annual payment updates that match what hospital outpatient departments receive. It also caps what Medicare patients have to pay out of pocket for surgery at an ambulatory center—their copayment can't exceed the annual hospital deductible (which is $1,556 in 2023). This means patients might pay less if they choose an ambulatory surgical center instead of a hospital for the same procedure.

The bill also requires Medicare to post quality and safety data on Medicare.gov so patients can compare ambulatory surgical centers and hospital outpatient departments side-by-side in their area. This helps people make informed decisions about where to have surgery. Additionally, the bill ensures that ambulatory surgical centers have a voice in how Medicare payment policies are decided by requiring at least one center representative on the advisory panel that makes these decisions. Finally, when Medicare decides not to allow a new procedure at ambulatory surgical centers, the agency must publicly explain why, citing specific medical evidence for the decision.

Outpatient Surgery Quality and Access Act of 2021

Larson, John B.

Outpatient Surgery Quality and Access Act of 2021 This bill establishes and modifies certain requirements relating to Medicare payments for ambulatory surgical center (ASC) services. Specifically, the bill (1) requires the payment system for ASC services to feature certain positive annual adjustments equivalent to those made with respect to hospital outpatient department (OPD) services; (2) revises quality reporting requirements to&nbsp;permit publicly available, side-by-side comparisons of quality measures for ASCs and OPDs in the same geographic area; and (3) requires the Centers for Medicare &amp; Medicaid Services (CMS), when excluding&nbsp;requested procedures from the list of those approved to be performed in ASCs, to cite specified reasons for doing so. With respect to excluding procedures from the approved list for ASCs, the CMS may not cite as a basis for exclusion that a procedure can only be reported using an unlisted surgical procedure code.&nbsp;(Physicians sometimes use unlisted codes when performing new procedures or services if no existing code is adequately descriptive.) The bill also limits the copayment amount for ASC services under Medicare to that of the inpatient hospital deductible.