by William Prentice

With the fourth quarter of 2014 fast approaching, ASCA and the ASC community are looking forward to seeing the final rule that will set Medicare reimbursement policies for ASCs that provide services to the program’s beneficiaries in 2015. This rule is due out from the Centers for Medicare & Medicaid Services (CMS) on or around November 1. If it mirrors the proposed rule that CMS released in July, Medicare and its beneficiaries have a lot to gain.

ASCA and the ASC community have long advocated for changes to many of CMS’ policies to allow ASCs to better serve the Medicare patient population and increase savings to the Medicare program. Demonstrating that these efforts are having an impact, several policies that CMS included in its proposed 2015 ASC payment rule would do exactly that. Let’s look at three.

1. CMS proposed to add 10 new spine procedures to the ASC list of payable procedures for 2015. The codes for these procedures are:

  1. 22551 Neck spine fuse & remov bel c2
  2. 22554 Neck spine fusion
  3. 22612 Lumbar spine fusion
  4. 22614 Spine fusion extra segment
  5. 63020 Neck spine disk surgery
  6. 63030 Low back disk surgery
  7. 63042 Laminotomy single lumbar
  8. 63045 Removal of spinal lamina
  9. 63047 Removal of spinal lamina
  10. 63056 Decompress spinal cord

ASCA representatives conducted a presentation for CMS staff earlier this year that highlighted the safety and efficacy of these procedures when performed in the ASC setting. This team of ASC professionals also provided CMS staff with outcomes data from centers across the country that are routinely performing these procedures. Based on that data, CMS made a wise choice in proposing to include these procedures on its list of procedures that it will reimburse ASCs for providing.

2. CMS’ proposed rule defines ASC device-intensive procedures as those procedures that are assigned to any Ambulatory Payment Classifications or APC (not only an APC formerly designated device-dependent) with a device offset percentage greater than 40 percent based on the standard Hospital Outpatient Prospective Payment System (OPPS) APC rate-setting methodology. The previous threshold was 50 percent. ASCA and the ASC community have been involved in ongoing conversations with CMS officials over this issue and advocating strongly for a lower threshold for some time. This proposed change is a strong step in the right direction.

3. Citing operational difficulties involved in reporting this measure, CMS proposed to make ASC-11: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery a voluntary measure in Medicare’s ASC Quality Reporting Program. ASC-11 is a physician-level measure that does not speak to the quality of the ASC, and ASCA worked closely with a coalition of representatives from the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery and the Outpatient Ophthalmic Surgery Society to influence CMS and raise awareness in Congress. This coalition, along with hospital associations, sent a letter to CMS Administrator Marilyn Tavenner in spring explaining that ASC-11 is inappropriate as a facility measure. On this issue too, in its proposed rule, CMS makes the right choice.

All three of these proposed changes benefit the Medicare program and its beneficiaries in key ways. They enable Medicare patients to have the surgical procedures that they need in less time, at less cost and with less hassle. They also offer the Medicare program significant savings.

Still, CMS’ final ASC payment rule could deviate from the proposed rule. If you are reading this message before September 2, 2014, you still have time to help make certain that these proposed changes are adopted. Please help ASCA and ASCs across the country by taking about 10 minutes to submit your comments on these issues using the materials available at www.ascassociation.org/2015ProposedRuleComments.

Despite the good news, ASCs are still working with CMS to resolve many other issues that prevent the Medicare program and its beneficiaries from taking full advantage of the many benefits that ASCs offer. One of our key concerns is that, again, in this proposed rule, CMS continues to use an inappropriate measure of inflation, the Consumer Price Index for All Urban Consumers (CPI-U), to update ASC rates. The CPI-U takes into consideration the cost of consumer goods, such as gas, milk and eggs. In contrast, CMS used the more appropriate Hospital Market Basket cost measure — which contemplates costs associated with healthcare facilities, such as medical equipment, gauze and nursing costs — to update the hospital outpatient department (HOPD) rates. Under this proposal, the rates paid to ASCs and HOPDs continue to diverge in 2015.

If this piece of the proposed rule is finalized for 2015, ASCs will be paid 54 percent of what HOPDs are paid to perform the same procedures. This growing disparity between ASC and HOPD rates is fueling ASC to HOPD conversions, stalling new growth in the ASC community and inflating costs for the Medicare system and patients.

ASCs can do much more to benefit Medicare beneficiaries. ASCA will continue to reach out to CMS policymakers to educate them on the many additional procedures that ASCs could safely and effectively perform for its beneficiaries and policies that might allow patients better access to care in the ASC setting.

If you work in an ASC that is not already an ASCA member, I encourage you to make sure that your facility becomes a member. Begin by calling Mykal Cox of our Membership Services team at 703.836.8808 ext. 114.

If you are already a member, I encourage you to get more involved with ASCA. If you don’t already receive the ASCA News Digest and our Government Affairs Update, please contact asc@ascassociation and ask to be added to our distribution lists for these weekly e-newsletters. If you haven’t participated in one of our Capitol Fly-Ins, consider joining us. Make sure that you are staying connected to the ASC community using our members-only online networking tool ASCA Connect. Information about all of these opportunities and more is on ASCA’s web site at www.ascassociation.org. Please visit us there regularly and write or call us anytime that we can be of service to you.

William Prentice is the chief executive officer of the Ambulatory Surgery Center Association.