2019 Proposed Payment Rule Comment Resources

Submit Your Comment Letter to CMS

All comments must be submitted by September 24.

Template Letters

ASCA has provided sample comment letters that your facility can customize before submitting to CMS.

Download Sample Comment Letters

The following templates are available:

  • Spine Codes Letter (For Physicians): A sample comment letter for ASC physicians to encourage CMS to continue reimbursing for spine codes in the ASC setting.
  • Spine Codes Letter (For Administrators): A sample comment letter for ASC administrators to encourage CMS to continue reimbursing for spine codes in the ASC setting.
  • Procedure List Letter: A general template letter requesting that codes be added to the ASC-payable list.
  • Non-Opioid Pain Management Letter: A sample comment letter supporting CMS' proposal to pay separately for non-opioid pain management therapy.
  • Secondary Rescaling Letter: A sample comment letter requesting that CMS remove the secondary rescaling that is applied to ASC payments.

The most effective letters incorporate your facility-specific information. In addition, if possible, you should copy and paste the comment letter onto your center's own letterhead.

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

Sample Language

Below is sample language that can be incorporated into comments if you would rather not submit a formal letter, or want to mix and match issues. The most persuasive comments will also include individual details regarding how the proposed changes will impact your center. Once again, comments can be submitted here.

Use of Hospital Market Basket as ASC Update Factor

We support CMS’ proposal to stop using 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.

Aligning the outpatient update and productivity factors across two settings will help minimize the silos around settings of care that are inconsistent with the agency’s desire to harmonize payments.

Cost Savings to Medicare and Beneficiaries

ASCs play an integral role in the health care delivery system because they save the system and beneficiaries money by being efficient and lean without compromising quality and stellar outcomes. Recent studies highlighting the cost savings and quality care in ASCs are listed below.

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 health care facilities within the Medicare system.

Cost savings – government study:

The US Department of Health & 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, while 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. There are currently 352 codes which are reimbursable when performed in the HOPD but not the ASC. If procedures are safe and appropriate in HOPDs that look and operate essentially like freestanding ASCs, they are safe and appropriate in ASCs, and we request that these codes be added to the ASC-payable list.

Codes your facility believes should be added (please add your specific requests):
Our 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. [More persuasive letters will include clinical data. If there are procedures currently on the ASC-payable list that are clinically-similar to the requested codes, that also helps].

Device-intensive policy:
We support CMS’ proposal to drop the device threshold. Currently, if ASC services have device costs that are less than 40 percent of the overall cost in the HOPD setting, the conversion factor is applied to the entire relative weight for the service, effectively discounting the payment for the device by more than 40 percent over what is paid to the HOPD. Since an ASC’s non-device reimbursement is approximately 53 percent of that in the HOPD setting, procedures that may be clinically appropriate for the ASC setting are not migrating to the ASC due to inadequate reimbursement. We believe that this policy change will enable appropriate migration of services to the ASC setting.

Submitting Comments

Click the "Submit Comments" button below when you are ready to send your letter to CMS. Remember, all comments must be submitted by September 24.

Submit Comments

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