2015 Proposed Payment Rule Comment Resources

Submit Your Comment Letter to CMS

All comments must be submitted by September 2.

Download ASCA's Draft Comment Letters

ASCA has provided draft comment letters that your facility can customize for submitting to CMS. There are separate letters for three different aspects of the proposed rule: spine codes, ASC-11 and the CPI-U. Letters should also include specific information such as your center's case volume, outcomes data, etc. If possible, you should copy and paste the comment letter into your center's own letterhead.

For help customizing your letter, please contact Kara Newbury at knewbury@ascassociation.org.

Sample Language

Below is sample language that can be incorporated into your comments. The most persuasive letters will also include individual details regarding how the proposed changes will impact your center.

Use of CPI-U as ASC Update Factor

CMS must replace the Consumer Price Index for Urban Consumers (CPI-U) as the mechanism to update ASC payments. The market basket that adjusts hospital outpatient department (HOPD) payments more closely reflects the cost structure of ASCs than does the basket of goods implied by the CPI-U. Further, the Affordable Care Act requires CMS to reduce the update by a measure of productivity gains, which inappropriately subjects ASCs to two productivity adjustments: improvements reflected in the price of consumer purchased goods and the additional ACA-mandated reduction. Aligning the outpatient update and productivity factors across two settings will help minimize the silos around settings of care that are inconsistent with the Secretary’s desire to harmonize payments.

Cost Savings to Medicare and Beneficiaries

ASCs play an integral role in the health care delivery system because they are able to save the system and beneficiaries money by being efficient and lean without compromising quality and stellar outcomes.

Recent Research Highlighting Cost Savings and Quality Care

Cost savings – industry-driven study:
An analysis by researchers at the University of California-Berkeley Nicholas C. Petris Center on Health Care Markets and Consumer Welfare found that ASCs saved the Medicare program and its beneficiaries $7.5 billion during the four-year period from 2008 to 2011 over what would have been paid if care had been provided in other settings. The Berkeley researchers also project that ASCs have the potential to save the Medicare system an additional $57.6 billion over the next decade if policymakers take steps to encourage the use of these innovative healthcare facilities within the Medicare system.

Cost savings – government study:
The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) found that outpatient surgical procedures performed in ASCs saved Medicare almost $7 billion and saved beneficiaries an additional $2 billion during CYs 2007 through 2011, and have the potential for even greater savings in the future.

Efficiency and quality outcomes, even on more vulnerable patient populations:
A study published earlier this year in the prestigious journal Health Affairs found that ASCs both save money and increase efficiency within the Medicare system, even as they “provide high quality care, even for the most vulnerable patients.”

Procedure List

General comments:
With technological advances driving procedures from the inpatient to the outpatient setting, we urge CMS to leverage the high-quality and cost-effective care that ASCs provide by adding procedures to the list of ASC covered services. It is common for HOPDs to be located off the hospital’s main campus and look a lot like freestanding ASCs. If procedures are safe and appropriate in HOPDs that look and operate essentially like freestanding ASCs, they are safe and appropriate in ASCs.

ASC physicians have identified these procedures as those that result in positive outcomes when performed on non-Medicare patients in the ASC setting, and should be added to the ASC list of covered procedures.

Spine code additions:
ASCA appreciates CMS’ willingness to move the 10 spine procedures listed below to the ASC list of payable procedures for 2015:

22551

    

Neck spine fuse&remov bel c2

     

22554

    

Neck spine fusion

     

22612

    

Lumbar spine fusion

     

22614

    

Spine fusion extra segment

     

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


However, these procedures are commonly done in conjunction with other codes not included (some unfortunately still on the inpatient only list).

For instance, CPT code 22551, is usually performed in conjunction with the instrumentation code of 22845 and the cage code of 22851 and the allograft structural code of 20931. Currently code 22845 is on the inpatient only list; therefore surgeons will most likely continue to perform procedure 22551 inpatient at the hospital. In order to prevent that from happening CMS would need to add 22845 to the outpatient hospital department and ASC list. I urge CMS to add code 22845 to the ASC list in order to facilitate the performance of Anterior Cervical Fusion’s in an ASC setting. These procedures are routinely performed in an ASC setting effectively and efficiently.

Also, codes 63020, 63030, 63047, 63045 and 63056 all have additional level codes. The additional level codes of 63035, 63048 and 63057 are on the outpatient hospital list but did not make it onto the ASC list. I respectfully request that these codes be added to the ASC list.

Quality Reporting

General comments:
ASCs play an integral role in the health care delivery system because they are able to save the system and beneficiaries money by being efficient and lean without compromising quality and stellar outcomes. The ASC industry asked for the additional administrative burden of a quality reporting program to demonstrate that their centers provide equal value to the hospital outpatient surgical experience. Last year was the first full year of data reporting under this program, and we appreciate the opportunity to report on indicators of clinical processes and outcomes of care. With this data, we believe the Centers for Medicare and Medicaid Services (CMS) and consumers will have even stronger evidence of the high quality care provided in this setting.

Proposed change to make ASC-11 (Cataract Quality Measure) voluntary:
We applaud the decision by CMS no longer require ASCs to report ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NQF #1536).

We strongly support quality reporting, and appreciate the ongoing effort the agency has devoted to the ASC Quality Reporting (ASCQR) Program. However, we do not believe that this measure proposed is appropriate for the ASC setting. ASC-11 is already included in the physician quality reporting system (PQRS) for clinician reporting. This is appropriate, as the measure relies on the use of data obtained or generated by the physician and recorded in the medical records housed in the physician’s office. CMS should continue to look to the entity that can logically be held accountable for measure results and is best able to take action to meaningfully improve performance. In the case of this measure, it is the physician, and not the facility, that is in the position to report on this data.