A caveat: A cardiac procedure performed in an ASC may cost a Medicare beneficiary more

One mitigating factor hospital executives can take note of regarding the possible shift in cardiac procedures from hospitals to ASCs: For a Medicare beneficiary who is considering out-of-pocket costs, the shift actually could make a hospital more attractive as a site of service.

A Medicare beneficiary undergoing an outpatient procedure is responsible for 20% of the approved payment for that service. If that procedure is performed at an outpatient hospital, that coinsurance is capped at the part A deductible, currently $1,364. If that same service is performed at an ASC, there is no cap on the out-of-pocket beneficiary obligation. That means any procedure with an ASC-approved payment of over $6,820, which includes joint replacement and cardiac stenting approved in 2020, would result in some Medicare beneficiaries without supplemental plans paying more out-of-pocket than if they had the procedure performed at the hospital on an outpatient basis.

Nonetheless, this point is unlikely to be included with the patient’s informed consent on having the procedure performed at an ASC.