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2013 Proposed Medicare Payment Rates Released

July 9, 2012

The Centers for Medicare & Medicaid Services (CMS) released the 2013 proposed payment rule for ASCs and hospital outpatient departments (HOPDs) today.

Click here to download a copy of the rule.

The following are a few initial observations about the proposal. ASCA will be providing additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally.

  • Continued Inequitable Treatment of ASCs. ASCA is disappointed that the agency chose to continue to use an inappropriate measure of inflation, the Consumer Price Index for All Urban Consumers (CPI-U), to update ASC rates. In contrast, CMS used a more appropriate cost measure to update the HOPD rates. The result is that under the proposal, the rates paid to ASCs and HOPDs will continue the troubling trend of diverging in 2013.

The chart below illustrates that the gap between ASC and HOPD reimbursement rates continues to grow:

 

ASC

HOPD


Inflation update factor


2.2% 

3.0% 


Affordable Care Act mandated

productivity reduction

0.9
percentage points    

0.8
percentage points 


Additional reduction mandated by     

the Affordable Care Act

NA 

0.1
percentage points 


Effective update


1.3% 

2.1% 


Conversion factor


$43.190 

$71.537 

  • No additional quality measures proposed. Noting “the time and effort required on the part of ASCs to plan and prepare for quality reporting,” CMS indicated that it is not proposing to require any additional quality measures beyond the eight measures it has previously established.

  • 16 new procedures proposed. The agency has proposed to add 16 procedures to the ASC list of payable procedures beginning January 1, 2013 (see Table 39 beginning on page 395 of the proposal). In addition, five new mid-year codes (0302T, 0303T, 0304T, 0307T and 0308T) will be added effective July 1, 2012.

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 "Preparing for 2013: Medicare's Proposed Rule."