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Years of Advocacy Lead to Improved Access to ASCs

By William Prentice

Thanks to decades of advocacy driven by ASCA and ASC supporters across the country, ASCs are starting 2019 with some new policies and programs in place that we expect to help patients gain increased access to the top-quality, high-value outpatient surgery care that ASCs provide.

Several of the new policies came with release of Medicare’s final ASC payment rule back in November. In this rule, after years of requests from the ASC community, the Centers for Medicare & Medicaid Services decided to begin using the hospital market basket rather than the Consumer Price Index for All Urban Consumers (CPI-U) to determine the amount of the annual inflation update ASCs receive under the program each year. ASC advocates have long maintained that the hospital market basket, a reflection of the cost of a mix of goods and services involved in providing hospital services, was a far more appropriate measure of inflation in ASCs than the CPI-U, which is based on the cost of consumer goods like gasoline and bread.

CMS’ decision to use the hospital market basket for ASCs also means that ASC inflation updates are now being determined using the same update factor as hospital outpatient departments (HOPD). This should help curtail the growing disparity between ASC and HOPD reimbursement rates that we have seen since the ASC payment system was tied to the HOPD payment system back in 2008. Although payments for the two sites of service will not be equalized under this new rule, the ASC community was not asking for parity and applauds CMS for this decision.

Another important change introduced in the 2019 payment rule is the reduction of the threshold definition of device intensive procedures in ASCs from 40 percent to 30 percent of the overall cost of the procedure in the HOPD setting. Thanks to this lower percentage, we estimate that ASCs can now provide 124 procedures to Medicare beneficiaries that they could not provide before due to the expense of the devices involved.

Because Medicare’s 2019 payment rule also expands the definition of surgery to include “surgery-like” procedures, ASCs are now able to provide an additional 12 cardiac catheterization procedures, plus five other procedures typically performed alongside those codes, to Medicare beneficiaries. ASCs have been performing these procedures with excellent outcomes for patients outside the Medicare program for some time and welcome this expanded access for Medicare patients.

The payment rule also contains other policies that support patient access to ASCs, including affirmation that new procedures added to the ASC list of payable procedures in the last few years have been added appropriately and separate payment for non-opioid pain control.

Thanks to the support that ASCs enjoyed on Capitol Hill in the last two years, two important pieces of legislation were adopted that we expect to have far-reaching effects on patient access to ASCs in 2019 and beyond. The first, the VA MISSION Act, reforms the U.S. Department of Veterans Affairs (VA) health care system, creates a Veterans Community Care Program and institutes a new, more reliable claims reimbursement process within VA that should allow ASCs to serve more veterans.

The second, the 21st Century Cures Act signed in December 2016, mandated that CMS develop a tool allowing the public to compare average costs between HOPDs and ASCs for outpatient surgery procedures performed in both settings. That tool – Procedure Price Lookup – came online in December. Of course, there is no substitute for the conversations patients need to have with their physicians before having surgery, but this tool goes a long way in empowering patients to make informed decisions about their care and containing the cost of that care.

ASCA extends its thanks to all the members of the ASC community who have devoted long hours of dedicated service to educating their elected and appointed officials about the many benefits ASCs provide. The ASC community thanks all the policymakers who have listened, recognized the many benefits ASCs offer and acted to support the ASC model of care.

As I write this message, other proposals CMS issued last year to reduce the regulatory burdens ASCs face are still pending. ASCA is also continuing to work with the agency to fine tune our quality reporting program and look at expanded opportunities for collaboration. On Capitol Hill, we are looking forward to continuing to work with our many champions who have emerged there over many years and beginning to get to know those who are serving for the first time.

We expect 2019 to be another important year for ASCs and invite everyone working in or with an ASC to join us in our advocacy efforts. If you would like to be more involved, please contact Danielle Kaster at dkaster@ascassociation.org. If you want information about membership, please contact Mykal Cox at mcox@ascassociation.org.

 

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