CMS Proposes Rate Increases of 0.9% for ASCs, 1.5% for HOPDs in 2012

Medicare payment rates for outpatient surgical services will increase by a proposed 0.9% for ambulatory surgery centers and 1.5% for hospital outpatient departments in 2012, according to a proposed rule now open for public comment.

Despite lobbying efforts from the ASC industry and members of Congress to base payments for both settings on the hospital market basket update, the Centers for Medicare and Medicaid Services will continue to base ASC payment updates on the consumer price index for all consumers (CPI-U), which the agency estimates to be 2.3% next year. When the projected 1.4% productivity adjustment, a measure of economy-wide productivity gains, for ASCs is applied to that figure as mandated by the Affordable Care Act, the total proposed rate change is 0.9%.

That's a full 0.6 percentage points lower than the projected 1.5% rate increase for HOPDs, which is based on a 2.8% projected market basket increase, a 1.2% productivity adjustment for HOPDs and an additional 0.1% adjustment needed to comply with the Affordable Care Act, according to the proposed rule.

Responding to the proposal, the Ambulatory Surgery Center Association says it's "extremely disappointed that [CMS] has continued to ignore the widening gap in payments for outpatient surgical services in these two settings."

Another notable change for ASCs included in the proposed rule is a new voluntary, confidential quality reporting program. As of next year, ASCs that choose to participate can report 7 outcome and surgical infection control measures on Medicare claims and an additional healthcare-associated infection measure through the National Healthcare Safety Network. Beginning in 2013, ASCs that fail to report these quality measures will face reduced payment rates.

The proposed quality measures for ASCs, which will be used to determine payment rates for 2014, include patient falls and burns; wrong-site, -side, -procedure or —implant errors; hospital transfers/admissions; selection and timing of prophylactic antibiotics; appropriate hair removal; and surgical site infection rates. CMS is proposing 2 additional measures — safe surgery checklist use and ASC facility volume data on selected procedures — to be added later for determination of 2015 payment rates.

For more details on CMS' proposed policy and payment changes for ASCs and HOPDs in 2012, read the proposed rule here. CMS is accepting comments until Aug. 31, 2011, and will issue a final rule by Nov. 1.

Irene Tsikitas