As you can see, the reimbursement and cost sharing amount for the hospital-based outpatient facility is almost twice the amount required for the ASC facility. It is the same procedure, provided by the same physician regardless of setting.
Before you answer the discussion question below, consider the following:
Is the quality of care two times better in the outpatient hospital facility setting?
Are the outcomes of care two times better in the outpatient hospital facility setting?
Are the costs of providing services and care that much lower in the ASC setting?
Are Medicare beneficiaries aware of the disparity of cost-sharing amounts in different surgical settings?
Is it fair to charge different cost-sharing amounts for the same service?
Do you think the difference in cost-sharing would influence your decision about where to have surgery?
Discuss the disparity between the reimbursement and cost-sharing levels of the outpatient hospital facility and ASC. Why is parity and disparity an important topic to discuss? How does it affect the average Medicare beneficiary? What do you think Genie should do? Are there additional questions that Genie should ask Dr. Williams before she makes her decision?
More questions to you should include in your response:
– Is the quality of care two times better in the outpatient hospital facility setting? Is the quality of care any better in the outpatient hospital facility setting?
– Do you think Medicare beneficiaries are aware of the disparity of cost-sharing amounts in different surgical settings? How could they be better educated?
– Do you think the difference in cost-sharing would influence your decision about where to have surgery?
