ASCA’s Efforts Produce Gains for ASCs in Medicare’s 2015 Proposed Payment Rule

July 10, 2014

The 2015 ASC payment proposal released by the Centers for Medicare & Medicaid Services (CMS) last week accommodates several important requests made by ASCA and the ASC community.

First, CMS is proposing to add 10 new spine procedures to the ASC list of payable procedures for 2015. In April, ASCA representatives discussed these 10 procedures with CMS payment policy staff and highlighted the safety and efficacy of these procedures when performed in the ASC setting. The ASCA representatives recommended that all be added to the list of procedures that Medicare will reimburse ASCs for providing. For these procedures to be included in the 2015 final rule, however, CMS must hear now from those who support the idea. Please click here to submit your comment urging CMS to accept the proposed addition of these ten procedures to the ASC list. ASCA will have sample language that can be incorporated into your comments by the second week of August, and will promote it once it becomes available.

CMS is also proposing to define ASC device-intensive procedures as those procedures that are assigned to any APC (not only an APC formerly designated device-dependent) with a device offset percentage greater than 40 percent based on the standard OPPS APC rate-setting methodology. The previous threshold was 50 percent, and ASCA has advocated strongly for a lower threshold.

Finally, citing operational difficulties with the measure, CMS has proposed to make ASC-11: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery a voluntary measure in the ASC Quality Reporting Program. Since this measure was proposed, ASCA has been voicing its concerns to CMS quality reporting staff about the measure’s appropriateness in the ASC setting.

The 2015 Medicare payment proposal, however, continues to promote a growing gap between ASC and hospital outpatient department (HOPD) payments by using the Consumer Price Index for All Urban Consumers (CPI-U) to update ASC rates. In contrast, CMS used the more appropriate Hospital Market Basket cost measure to update the HOPD rates. As a result, CMS is proposing an effective payment update of 1.2% for ASCs and an effective payment update of 2.1% for HOPDs.

“Leaving aside our concerns about the inappropriate use of the CPI-U to update ASC payments, we are very pleased that our outreach efforts are making headway with CMS policymakers,” said ASCA CEO Bill Prentice. “ASCs can do so much more to benefit Medicare beneficiaries, and we hope the successes in this draft rule are retained in the final version and that we can build upon them going forward.”

Register for ASCA’s webinar “Understanding Medicare’s Proposed Rates for 2015” on Tuesday, August 5, at 1:00 pm ET to gain important insights into the proposed changes to CMS’ 2015 ASC payment system and ASC Quality Reporting Program.