Reaction mostly positive to proposed pay rule

Reaction mostly positive to proposed pay rule

The 2015 ambulatory surgery center (ASC) and hospital outpatient department (HOPD) payment proposal released by the Centers for Medicare & Medicaid Services (CMS) "accommodates several important requests made by ASCA and the ASC community," according to the ASC Association (ASCA).

CMS proposes adding 10 spine procedures to the ASC list of payable procedures for 2015. (See list, above right.)

Another victory for ASCs comes in a CMS proposal to define ASC device-intensive procedures as those procedures that are assigned to any ambulatory payment classification (APC) — not only an APC formerly designated device-dependent — with a device offset percentage greater than 40% based on the standard outpatient prospective payment system (OPPS) APC rate-setting methodology. "The previous threshold was 50%, and ASCA had advocated strongly for a lower threshold," according to the ASCA.

Also, 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. CMS cited operational difficulties with the measure, the ASCA said. "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 organization said.

CMS is proposing to add a new measure, "ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy," according to the ASCA. The quality measure would affect payment in CY 2017, with data collection beginning in CY 2015. This measure will be a claims-based measure, the ASCA says.

The response isn’t all positive from ASCs, however. There continues to be "a growing gap" between ASC and HOPD payments., the ASCA said CMS is proposing an effective payment update of 1.2% for ASCs and an effective payment update of 2.1% for HOPDs in hospitals reporting required quality data. Hospitals not reporting data would see payments rise by 0.1%.

Also, CMS proposes hospitals and physicians be required to report a modifier with each procedure code billed under the physician fee schedule and in the OPPS when services are provided in an off-campus provider-based department, according to the American Hospital Association (AHA). The proposal is part of an "effort to better understand the impact of the trend of hospitals’ acquiring physician offices and transforming them into provider-based departments" the AHA said.

The proposed rule appeared in the July 14, 2014, Federal Register and can be downloaded at http://1.usa.gov/1nfPT82. At press time, the ASCA said it would have sample language that can be incorporated into comments on the proposed rule by the second week of August at http://bit.ly/1x0KpxT. CMS will accept comments on the proposed rule until Sept. 2, 2014, and will respond to comments in a final rule to be issued on or about Nov. 1, 2014.