Potentially good news for ASCs: A bipartisan group of 21 senators has asked CMS to fix the ambulatory surgery center payment update. In a letter submitted to CMS Administrator Don Berwick, MD, the senators asked CMS to use the hospital market basket, the index used for payment updates to hospital outpatient departments, instead of the Consumer Price Index for all Urban Consumers (CPI-U) to update ASC payments in 2011.
"Recently, CMS proposed to update payments to ASCs by 1.6% (CPI-U) for the 2011 payment year. However, this would in effect freeze payments to ASCs due to application of a 1.6% productivity adjustment beginning next year," the senators write.
ASCs are the only healthcare facilities that receive payment updates based on CPI-U, a measure of inflation for goods and services purchased by consumers, based largely on prices for energy and housing, notes the ASC Advocacy Committee. Unlike the CPI-U, the hospital market basket is a direct measure of inflation for the goods and services purchased by healthcare facilities. In March 2010, the Medicare Payment Advisory Commission's (MedPAC) annual report to Congress also acknowledged that the CPI-U is an inaccurate mechanism for updating ASC payments.
Basing payment updates on the CPI-U versus the hospital market basket contributes to the increasing gap between ASC and HOPD payments rates, says the ASCAC. Over the last 7 years, the relationship between ASC and HOPD payments fell from 86% to 58% for identical services, and the payment gap will continue to increase as long as payment updates for ASCs are tied to the CPI-U.
CMS should use the same index when updating HOPD and ASC payments to ensure that ASC payments accurately reflect the inflationary pressures faced by the ASC industry and to ensure that ASCs have the resources needed to implement new technology, enhanced reporting systems, and the ability to continue providing high quality, patient-centered care at a low cost to the patient and health care system, says the ASCAC.
Dan O'Connor
