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Medicare's 2015 Final Rule Released; ASCA Efforts Result in Victories for ASCs

October 31, 2014

The Centers for Medicare & Medicaid Services (CMS) released its final 2015 ASC payment rule today. ASC payment rates will increase by 1.4 percent in 2015. This increase is based on a projected rate of inflation of 1.9 percent minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act. This payment update is higher than the 1.2 percent update in the proposed rule, which was based on an inflation rate of 1.7 percent minus a 0.5 percentage point productivity adjustment.


According to the rule, hospital outpatient departments (HOPDs) will receive a 2.2 percent increase, based on a 2.9 percent market basket minus both a 0.5 percent adjustment for economy-wide productivity and a 0.2 percentage point adjustment required by statute. As in previous years, we proposed that CMS align the two update factors to prevent a continuing divergence in payment rates by using the hospital market basket to determine the update factor for ASCs.


“While we are pleased to see a slight increase in our payments over the proposed rule, we are extremely disappointed that CMS continues to undervalue ASC payments by using the CPI-U to update them when even their own actuaries have indicated that the CPI-U is inappropriate,” remarked ASCA CEO Bill Prentice. “Using different update factors for ASCs and HOPDs widens the gap between HOPD payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs and increases costs to the Medicare program, its beneficiaries and taxpayers who support the program."


CMS also finalized a significant change to its device-intensive policy that will benefit the ASC community. In its final rule, CMS defines ASC device-intensive procedures as those procedures that are assigned to any ambulatory payment classification (APC) group with a device cost greater than 40 percent of the total cost of the procedure in the HOPD setting. The previous threshold was 50 percent. ASCA has consistently advocated for a lower threshold, and in our comments to CMS, noted that there are approximately 163 procedures that are allowed to be performed in the ASC setting but are not because our facilities are not adequately reimbursed for the devices involved. Even at the 40 percent threshold there are 47 codes with high device costs that will now become economically feasible for ASCs to begin performing, saving Medicare and its beneficiaries millions of dollars annually.


With regards to the ASC-payable list, CMS did finalize the addition of the following nine spine codes:


22551

     

Neck spine fuse&remov bel c2

22554

     

Neck spine fusion

22612

     

Lumbar spine fusion

63020

     

Neck spine disk surgery

63030

     

Low back disk surgery

63042

     

Laminotomy single lumbar

63045

     

Removal of spinal lamina

63047

     

Removal of spinal lamina

63056

     

Decompress spinal cord


These procedures were included as a direct result of a presentation ASCA representatives conducted for CMS staff earlier this year that highlighted the safety and efficacy of these procedures when performed in the ASC setting. In addition, CMS agreed with ASCA’s assessment that CPT codes 22551, 22554 and 22612 were assigned to the wrong ambulatory payment classification (APC) group, and moved these codes to APC 0425 which has a higher reimbursement than then previous group to which they were assigned, APC 0208.


“ASCA appreciates CMS’ recognition that these procedures are safely and effectively performed in ASCs,” remarked Bill Prentice. “However, until such time as the devices and secondary codes ASCA requested in its comment letter are added to the ASC payable list, it will not be economically feasible for many of these codes to be performed in the ASC setting.”


Two other codes were also added to the ASC payable list, 22614 (Spine fusion extra segment) and 63044 (Laminotomy, additional lumbar), but are not separately payable as they have been packaged with other codes listed.


In terms of changes to the quality reporting program, CMS finalized its proposal to make ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery a voluntary measure in the ASC Quality Reporting Program (ASCQRP).


Unfortunately, CMS did finalize proposed quality measure ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy, despite the objections of many stakeholder groups including ASCA. Although there are significant problems with the measure’s validity, reliability and usability, there is no additional burden placed on a facility, as the measure will be reported by the hospital which the patient visits within seven days of the colonoscopy.


CMS did finalize the May 15, 2015 reporting deadline for ASC-8: Influenza Vaccination Coverage among Healthcare Personnel through the National Healthcare Safety Network (NHSN), which is managed by the Centers for Disease Control and Prevention (CDC). To report ASC-8 through NHSN as required, someone from your ASC must register with NHSN. (Tip: This registration process can take several weeks, so ASCs are advised to register immediately.) Click here for instructions.


Click here to download the final rule. ASCA will continue to analyze the rule in detail and will provide more information next week to help ASC operators understand the impact of the final rule on their centers.


For more information, contact Kara Newbury at knewbury@ascassociation.org.




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