Policy Statement on Site of Service Payment Adequacy

The American Society of Gastrointestinal Endoscopy recognizes the value endoscopic services provide in cancer prevention, including colorectal cancer, and in the treatment of many diseases pertaining to the digestive system.  Many of these procedures can be performed in the hospital outpatient and ambulatory surgery center (ASC) settings, as well as in office-based facilities. The decision of whether to perform these procedures in an outpatient facility as opposed to a hospital-based setting should be determined by the overall acuity and comorbidities of the patient, but decisions are also influenced by whether payment covers the costs associated with the procedure. Facility fee reimbursements are higher in the hospital outpatient-based setting compared to an ASC or office-based facility.  This payment differential is attributed to higher hospital operating costs and overall higher acuity of the patient in a hospital as compared to the outpatient ambulatory setting. 

Reimbursement must be adequate for the site of service in which care is provided.  As such, reimbursement should recognize the sometimes higher acuity and complexity of patients treated in the hospital, as well as current payment disincentives that unnecessarily limit access to care in the lower-cost ASC setting. ASGE opposes payment policies that neutralize payments across sites of service, commonly by driving payment down to the lowest reimbursed site of care.  Neutralized payments fail to recognize the differences in cost of care by site of service and mistakenly assume that ASC payment levels are adequate.

Approved by the ASGE Governing Board November 2018