Home E-Weekly July 18, 2017

Highlights of CMS's 2018 ASC Payment Rule

Published: July 17, 2017

JOINT EFFORT ASCs could soon begin receiving Medicare payments for joint-replacement procedures.

From paying surgery centers for total joints to delaying mandatory participation with a patient satisfaction survey, there are several positive developments in the 2018 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs), which the Centers for Medicare & Medicaid Services (CMS) released the last week.

Here's a breakdown of the key provisions of the 664-page proposed rule, which would be effective Jan. 1, 2018:

  • ASCs paid for total joints. ASCs could start receiving Medicare payments for 3 joint-replacement procedures: total knee arthroplasty; partial hip arthroplasty; and total hip arthroplasty. CMS is proposing to remove total knee arthroplasty from the inpatient-only list for 2018. In addition, CMS is soliciting comments on whether partial and total hip should also be removed from the inpatient-only list and added to the ASC Covered Surgical Procedures List.
  • Delay OAS CAHPS. CMS would delay requiring that facilities participate in the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey, also known as OAS CAHPS, "until further action in future rulemaking." For years, many in the ASC community have raised concerns about the size and intrusive nature of the survey, as well as the administrative and financial burdens associated with it. Under this proposal, ASCs that would like to continue to administer the 37-question survey voluntarily may do so, but there will be no mandatory adoption based on 2018 reporting.
  • Payment rate updates. ASCs would, on average, receive a 1.9% inflation update in 2018. HOPDs would receive a 1.75% update. CMS estimates the rate increases would generate an additional $5.7 billion for HOPDs and an additional $155 million for ASCs, based on estimated 2017 Medicare payments.
  • ASC quality reporting. CMS has proposed removing 3 measures under the ASC Quality Reporting Program, starting with the 2019 payment determination and subsequent years — ASC-5: Prophylactic Intravenous Antibiotic Timing; ASC-6: Safe Surgery Checklist Use; and ASC-7: ASC Facility Volume Data on Selected Procedures — and adopting 3 new measures, including ASC-16: Toxic Anterior Segment Syndrome, which would be collected via a web-based tool for 2021 payment determination and subsequent years, and ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures and ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures, which would be collected via claims for 2022 and beyond.
  • 3 new procedures proposed. CMS has proposed to add 3 new procedures to the ASC list of payable procedures for 2018: 22856 (Cerv artific diskectomy), 22858 (Second level cer diskectomy), and 58572 (Tlh uterus over 250 g).

CMS has not proposed further action regarding the establishment of a facility fee for office-based cataract surgery.

CMS will accept comments on the proposed rule until Sept. 11, 2017.

Bill Donahue

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