Name

Email

1 - Do you practice endoscopy in any of the following settings?

Office
Yes No

ASC
Yes No

Hospital
Yes No

2 -  By what percent will your Medicare and commercial patient mix change? [please indicate if change is positive (+) or negative (-)]

*first year of full implementation

3 - Will you stop accepting and treating Medicare patients?

Yes
No

If you answered Yes, in what year?

4 - Given all the factors, do you expect the waiting time for Medicare patients between the date it is determined they need a procedure to the date the procedure is performed will be longer, shorter, or about the same once the proposed payment changes take effect?

Longer wait time for Medicare procedures in the ASC

Shorter wait time for Medicare procedures in the ASC

About the same wait time as today

5 - Given all the factors, do you expect the waiting time for private pay patients between the date it is determined they need a procedure to the date the procedure is performed will be longer, shorter, or about the same once the proposed payment changes take effect?

Longer wait time for private pay procedures in the ASC

Shorter wait time for private pay procedures in the ASC

About the same wait time as today

6 - Assuming the new system is fully implemented as scheduled in 2011:

a. Do you expect that your ASC would see fewer Medicare patients in an average week?
Yes
No

b. Do you expect that your ASC would see more Medicare Patients in an average week?
Yes
No

c. Do you expect that your ASC would see fewer private pay patients in an average week?
Yes
No

d. Do you expect that your ASC would see more private pay patients in an average week?
Yes
No

e. Do you expect that the total number of patients seen in your ASC, regardless of type of payment would increase in a given week?
Yes
No

f. Do you expect that the total number of patients seen in your ASC, regardless of type of payment would decrease in a given week?
Yes
No

7 - As a physician helping patients to select where they will have their procedure performed, will you be more or less likely to recommend, for either medical or payment reasons, that Medicare patients receive their procedures in an HOPD?

More likely to recommend in HOPD

More likely to recommend in ASC

No change from present

8 - As a physician helping patients to select where they will have their procedure performed, will you be more or less likely to recommend, for either medical or payment reasons, that private pay patients receive their procedures in an HOPD?

More likely to recommend in HOPD

More likely to recommend in ASC

No change from present

9 - Given all the factors, do you expect the number of ASC facilities serving Medicare patients will expand, decrease or stay the same once the payment changes are fully implemented?

Expand

Decrease

Stay the same

10 - Given all the factors, do you expect the number of ASC facilities serving Medicare patients will expand, decrease or stay the same once the payment changes are fully implemented?

Yes:
Expand

Decrease

No:
Stay the same

11 - Roughly what percentage of Medicare patients do you currently recommend have their procedures performed in the HOPD?

%

12 - Assuming the changes in Medicare ASC payments are implemented, roughly what percentage of Medicare patients do you currently recommend have their procedures performed in the HOPD?

%

13 - Assuming the changes proposed by CME for Medicare ASC payments are implemented:

a. Do you expect that your ASC would close its business?
Yes
No

b. Will you expect to expand the size of your ASC?
Yes
No

c. Will you expect to increase the total number of hours per week that the ASC treats patients?
Yes
No

d. Will you expect to decrease the total number of hours per week that the ASC treats patients?
Yes
No

e. Will you expect an increase in the total number of employees at your ASC?
Yes
No

f. Will you expect a reduction in the total number of employees at your ASC?
Yes
No

g. Will you expect an increase in the average compensation level (salary and benefits) for the ASC’s employees?
Yes
No

h. Will you expect a reduction in the average compensation level (salary and benefits) for the ASC’s employees?
Yes
No

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