By Bill Prentice
Both the Centers for Medicare & Medicaid Services (CMS) and Congress turned their attention to ASCs at the end of 2021. CMS released its final 2022 Medicare payment rule for ASCs and four members of Congress sponsored new legislation promoting patient access to ASCs.
Under the final payment rule, ASCs received an effective update of 2 percent for 2022, beginning January 1. The amount was determined using a 2.7 percent inflation update based on the hospital market basket minus a 0.7 percentage point productivity adjustment required under the Affordable Care Act. The update is the same amount hospital outpatient departments received and a step toward greater parity in the systems used to determine reimbursements for both settings that ASCA has been requesting for some time.
In other good news for ASCs, CMS adopted a new formula related to device-intensive procedures that is based on ASC rates rather than HOPD rates as in the past. Under the new policy, any procedure for which the device cost is 30 percent of the overall ASC procedure rate will receive device-intensive status. ASCA has long supported this change. The rule also takes this policy decision one step further, asserting that any device that receives device-intensive status in the HOPD setting will also be device-intensive in the ASC setting.
Unfortunately, in this rule, CMS is removing 255 of the 258 codes it had added to the ASC Covered Procedures List (ASC-CPL) in 2021. The three codes that will remain are:
- 0499T (Cysto f/urtl strix/stenosis)
- 54650 (Orchiopexy (fowler-stephens))
- 60512 (Autotransplant parathyroid)
This rule also brings back exclusionary criteria used previously to determine which procedures could be added to the ASC-CPL. These had been eliminated in 2021. This rule also halts the elimination of the inpatient-only (IPO) list that limits the procedures hospitals can perform as outpatient procedures. Although this list does not immediately impact the procedures ASCs can perform, it is of concern to ASCs because procedures often move off the IPO list and, later, into the ASC setting. Expecting that trend to continue, ASCA was pleased to see that, as ASCA requested, this rule kept three procedures from reverting back onto the IPO list: CPT codes 22630 (Lumbar spine fusion); 23472 (Reconstruct shoulder joint) and 27702 (Reconstruct ankle joint).
On another positive note, the rule finalizes CMS’ proposal to establish a new process that will give professional specialty societies and other external stakeholders an opportunity to nominate new procedures to the ASC-CPL. This, too, is something ASCA has long requested.
This rule also introduced some significant changes to Medicare’s ASC Quality Reporting program that can lead to Medicare payment reductions for ASCs that fail to comply. Not only are the criteria changing, some of the reporting methodology is changing as well. Some of the changes include:
- add a COVID-19 vaccination measure;
- resume reporting ASC-1, ASC-2, ASC-3 and ASC-4, this time as web-based measures, which will mean facilities will report on all patients, not just Medicare beneficiaries;
- require a new cataract-related measure, ASC-11, beginning with the CY 2025 reporting period, a delay from the start date contained in the proposed rule; and
- require the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-based measures beginning with voluntary reporting in CY 2024 and mandatory reporting in CY 2025, also a delay from the start date contained in the proposed rule.
ASCA will continue to advocate for some additional changes in these measures and provide resources to our members to help them comply with the new requirements.
The new legislation, known as the Outpatient Surgery Quality and Access Act of 2021 (H.R. 5818 and S. 3132), would
- require the Centers for Medicare & Medicaid Services (CMS) to publish relevant quality data in a way that allows patients to compare quality across sites of service;
- eliminate the copay penalty Medicare beneficiaries pay for certain Part B services when they are provided in an ASC;
- provide transparency regarding the criteria CMS is using to exclude procedures from the ASC Covered Procedures List;
- add an ASC representative to CMS’ Advisory Panel on Hospital Outpatient Payment, which makes decisions that affect both hospital outpatient department (HOPD) and ASC facility fees and eligible procedures; and
- align the inflation update and budget neutrality adjustment for ASCs and HOPDs.
Demonstrating the bicameral, bipartisan appeal of the bill, Representatives John Larson (D-CT) and Devin Nunes (R-CA) introduced the legislation in the U.S. House of Representatives and Senators Richard Blumenthal (D-CT) and Bill Cassidy, MD (R-LA) introduced the legislation in the U.S. Senate.
ASCA has already begun working to secure support for this legislation from other members of Congress and provides tools and opportunities for ASC physicians, owners and staff to help. If you work in or with an ASC and want to be involved, please contact Stephen Abresch at sabresch@ascassociation.org.
Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association (ASCA).
