Anesthesia Service Costs and Savings to Medicare From the Growth of ASCs

Abstract

To the Editor: In their letter to the editor, Drs Scheiman and Domonitz question the validity of our study conclusions that continued growth in the provision of colonoscopies at Ambulatory Surgical Centers (ASCs) would result in savings to Medicare (1). Their specific criticism is that our study, which focused on facility payments, excluded ancillary costs—particularly payments for anesthesia services. Drs Scheiman and Domonitz point to work demonstrating that the use of anesthesia services during a colonoscopy is higher in ASCs than in hospital outpatient departments (HOPDs) (2). Moreover, the use of these services has grown significantly and resulted in higher Medicare payments for colonoscopy over the last several years (3). Drs Scheiman and Domonitz argued that the savings from ASCs could “rapidly dissipate” if ancillary service costs are considered because of higher utilization of these services at ASCs.