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2016 Proposed Medicare Payment Rates Released

July 1, 2015

The Centers for Medicare & Medicaid Services (CMS) released the 2016 proposed payment rule for ASCs and hospital outpatient departments (HOPDs) today. Click here to download a copy.

Some initial observations about the 697-page proposal follow. ASCA will be providing additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.

1.1% rate update. If the proposed rule were to be finalized as drafted, ASCs would see an effective update of 1.1%—a combination of a 1.7% inflation update based on CMS’s estimation of the change in Consumer Price Index for All Urban Consumers (CPI-U) and a productivity reduction mandated by the Affordable Care Act of 0.6 percentage points. However, CMS does not take into account sequestration in its proposed rule. This statutory 2 percent reduction remains in effect until at least 2024 unless Congress acts.

The information below provides a comparison between the 2016 ASC and HOPD reimbursement proposals:



ASC


HOPD

Inflation update factor


1.7%


2.7%

Productivity reduction mandated by the ACA


0.6 percentage points


0.6 percentage points

Additional reduction mandated by the ACA


NA


0.2 percentage points

Effective update


1.1%


1.9%

Conversion factor


$44.605


$73.929

“Unfortunately, the proposed rule and continued use of the CPI-U to update ASC reimbursements offers more evidence of CMS’ unwillingness to recognize that the agency must do more to actively promote ASCs as a high quality, efficient provider of outpatient care for America’s seniors if we are to survive and thrive in the future,” noted ASCA CEO Bill Prentice.

11 new procedures proposed. The agency has proposed to add 11 new procedures to the ASC list of payable procedures for 2016. These codes are:

  • 0171T (Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; single level)

  • 0172T (Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; each additional level)

  • 57120 (Colpocleisis (Le Fort type))

  • 57310 (Closure of urethrovaginal fistula)

  • 58260 (Vaginal hysterectomy, for uterus 250 g or less J8)

  • 58262 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s))

  • 58543 (Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g)

  • 58544 (Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s))

  • 58553 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g)

  • 58554 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s))

  • 58573 (Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s))

CMS Proposes to Align Web-Based Quality Measure Reporting Dates. CMS has proposed that all web-based measures in the ASC Quality Reporting Program be reported by May 15 each year. Currently, the deadline for ASC-8 is May 15 (although the deadline was extended only for 2015) and the deadline for ASC-6, ASC-7, ASC-9 and ASC-10 is August 15. According to CMS, aligning the dates “would allow for earlier public reporting of measure data and reduce the administrative burden for ASCs associated with tracking multiple submission deadlines for these measures.”

No new quality measures. CMS is not proposing to add any new measures to the ASC Quality Reporting Program for the coming year.

ASCA will continue to analyze the rule in detail and will soon provide more information to help ASC operators understand the impact of the proposal on their centers.

Register for ASCA’s webinar “Medicare’s Proposed Changes to ASC Payment Policy for 2016” on Tuesday, August 4, at 1:00 pm ET.


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