By Bill Prentice
The Centers for Medicare & Medicaid Services (CMS) issued its 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD) in July. It invited all interested parties to submit comments by September 9.
ASCA conducted its own analysis and worked with numerous stakeholders, including other national organizations, various professional societies, state leaders, product and service providers, and surgery center physicians and managers, to prepare the association’s comments. ASCA also encouraged others to submit comments of their own.
Highlights of the proposal and ASCA’s responses follow.
An Effective Update of 2.6 Percent
Under the proposed rule, on average, ASCs would see an effective inflation update of 2.6 percent. This is the same increase as HOPDs; using the same inflation update factor is something ASCA has been supporting for many years. While ASCA is pleased to see CMS use the hospital market basket update factor for both HOPDs and surgery centers again next year, ASCA is also continuing to encourage CMS to make that arrangement permanent.
ASCA also provided CMS with numerous examples of the ways this small update falls short of covering the rising costs associated with the essential services and supplies ASCs need to have in their facilities to be able to continue to provide safe, high-quality care.
Changes to the ASC Covered Procedures List
Back in March, as part of a new process CMS instituted for recommending procedures for addition to Medicare’s ASC Covered Procedures List (ASC-CPL) – a process CMS calls the ASC-CPL Pre-Proposed Rule Recommendation Request – ASCA submitted 18 codes. They included 16 cardiovascular codes and two spine codes. This proposed rule did not mention those codes or provide any insight into any others suggested through that process.
ASCA’s comments conveyed its disappointment that none of those codes were mentioned and expressed concern over the lack of transparency in what CMS originally touted as a new, highly transparent process. Based on the information ASCA shared with CMS about these procedures, we continue to hope it will decide to add them in its final 2025 payment rule.
CMS did propose to add 20 medical and dental surgical procedures to the ASC-CPL. Whether the addition of these codes, as proposed, would provide greater access to dental procedures in surgery centers remains unclear.
Changes to the ASC Quality Reporting (ASCQR) Program
The quality reporting provisions in the proposed rule contained some news we expected and some new requirements we did not anticipate.
For example, we were not surprised to find that the proposed rule contained no changes regarding the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey. That survey is still set to become a mandatory component of the ASCQR Program on January 1, 2025. If you are in a surgery center that wants to remain compliant with Medicare’s quality reporting requirements to avoid future cuts in your reimbursement rates but are not already administering this survey, I encourage you to make that a priority now. This survey takes time to set up and, typically, even longer to generate the high-quality results that surgery centers are used to seeing. ASCA has numerous resources on its website at www.ascassociation.org/prepare-oas-cahps that can help.
Meanwhile, ASCA will continue to advocate for changes to this survey, such as an electronic-only option, to reduce the cost burden on facilities.
At ASCA, we were also disappointed but unsurprised to see that reporting on the COVID vaccination coverage measure, ASC-20, remains in place. We continue to contest the usefulness of this burdensome measure and request its removal from the ASCQR Program, or at the very least, reporting only once a year instead of selecting one week per month.
The unexpected news related to the ASCQR program is that CMS wants to add three new measures related to health equity.
The first of these would assess a “facility’s commitment to health equity” across five domains: equity as a strategic priority, data collection, data analysis, quality improvement and leadership engagement. The second would involve screening for Social Drivers of Health (SDOH) in food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety. The third measure would indicate the “screen positive rate” for patients identified using the second measure.
Both ASCA and the ASC Quality Collaboration oppose these new measures since none of them have been tested in the ASC setting. ASCA also expressed concerns about the benefits of these additional reporting measures and questioned the wisdom of adopting three additional measures in the same year the OAS CAHPS survey becomes mandatory.
Next Steps
CMS is now analyzing all the comments it received on its proposed rule and preparing to release its final rule. That rule is typically released near Halloween and is required by law to be released by November 2, or 60 days prior to its effective date of January 1, 2025.
To help support the critical advocacy work that ASCA is doing on behalf of surgery centers of every specialty across the country, please make sure that if you work in an ASC, your facility is an ASCA member (contact Mykal Cox at mcox@ascassociation.org to learn more). To learn more about Medicare’s final payment rule, check our website at ascassociation.org for updates.
