By Bill Prentice
With Donald Trump the declared winner of the U.S. presidential election in November, it is still too soon to say exactly what the next four years will mean for surgery centers. During his first term as president, Trump eliminated some regulatory burdens on surgery centers and added numerous additional procedures to the ASC Covered Procedures List (ASC CPL). Since the Biden Administration later removed many of those procedures, we will be watching to see if they are reinstated during Trump’s second term.
The congressional elections conducted in November brought some good news for the ASC community. As I write this, all of the sponsors of the Outpatient Surgery Quality and Access Act of 2023 who were running for re-election either won or were expecting to win their races when the final call is made. Three of the bill’s cosponsors in the House, however, decided not to seek re-election. Additionally, all the members of the 118th Congress running for re-election who had recently received ASCAPAC support were returned to office. Whatever else changes, one thing will remain the same: ASCA will continue to be involved in the policymaking decisions that affect surgery centers and continue to keep the ASC community connected and informed.
As 2025 begins, another change for many ASCs is that they will be administering the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey for the first time. Effective January 1, that survey is mandatory for all ASCs that want to remain compliant with the Centers for Medicare & Medicaid Service’s (CMS) Quality Reporting Program and avoid reduced Medicare reimbursement rates in 2027 and beyond.
ASCs that have not already selected and begun working with a vendor on the list of CMS-approved survey providers have a lot of work to do to before they will be able to administer this survey effectively. If you work in a surgery center and need help, I encourage you to visit the OAS CAHPS Survey information on ASCA’s website at www.ascassociation.org/oas-cahps-now.
New Medicare Payment Rules
As usual, the start of a new year means that ASCs are subject to new Medicare payment rules and rates issued by CMS back in November. In 2025, ASCs receive an effective update of 2.9 percent – a combination of a 3.4 percent inflation update based on the same Health Market Basket (HMB) index applied to hospital outpatient departments (HOPD) and a productivity reduction of 0.5 percentage points mandated by the Affordable Care Act and applied to HOPDs as well. It is important to note that this figure is an average, and actual updates can vary significantly by code and specialty.
While ASCA was pleased to see CMS apply the same update to ASCs and HOPDs again in 2025, we recognize this falls far short of covering the ever-escalating costs of providing care that all health care providers, including ASCs, face today. In addition, we continue to object to CMS’ continued use of a secondary scaling system the agency applies to ASC payments after the initial update is added. In 2025, the use of this system means that the disparity that already exists between ASC and HOPD payments will continue to grow. ASCA will continue to advocate for more adequate reimbursement for our facilities.
CMS also added 21 new procedures to the ASC CPL for 2025. That list is composed of 19 dental codes and two adipose-derived regenerative cell therapy codes (0717T [Adrc ther prtl rc tear] and 0718T [Adrc ther prtl rc tear njx]). CMS decided not to add any of the surgical procedures ASCA requested, a decision that is extremely frustrating in a time when millions of Medicare beneficiaries are relying on CMS to advance policies that expand their access to the high-quality, cost-effective care ASCs provide.
Changes to Quality Reporting
In 2025, the same year that the OAS CAHPS Survey becomes mandatory for ASCs, CMS also adopted three new measures for its ASC Quality Reporting (ASCQR) Program:
- the Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination;
- the Screening for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination; and
- the Screen Positive Rate for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination.
While ASCA strongly supports health equity and access to care for all patients, the information CMS has supplied to date on these new measures does not make clear how the measures will address the disparities that exist or how CMS will support the facilities required to collect this information. ASCA is advocating for the measures to be removed from the ASCQR Program, asserting that the ASC setting is not the proper site of service to obtain this data.
Like we have seen many times before, the new Medicare payment rules and rates that apply to ASCs in the coming year leave a lot to be desired when you consider what is needed to ensure continued patient access – and expanded access – to ASCs and all the benefits they provide. In 2025, ASCA is looking forward to working with the new administration and every member of Congress to bring about the change needed. We also hope that everyone who works in or with an ASC will join us. If you are interested in getting involved, please contact ASCA Manager of Government Affairs Maia Kunkel.
