Proposed pay for HOPDs, ASCs announced for 2014
The Centers for Medicare and Medicaid Services (CMS) has proposed a 1.4% inflation update factor for ambulatory surgery centers (ASCs) in 2014 and a 2.5% inflation update factor for hospital outpatient departments (HOPDs). However, with the production reduction for ASCs and HOPDs, and the additional reduction for HOPDs, mandated by the Affordable Care Act (ACA), the effective update is 0.9% for ASCs and 1.8% for HOPDs.
The proposed payment rule for 2014 disappoints leaders of the ASC Association (ASCA) due to what they say is "continued inequitable treatment of ASCs." ASCA leaders say that using the Consumer Price Index for All Urban Consumers (CPI-U) to update ASC rates is "inappropriate." Hospitals are updated using the Hospital Market Basket, which ASCA leaders feel is more appropriate for ASCs. "The result is that under the proposal, the rates paid to ASCs and HOPDs will continue the troubling trend of diverging in 2014," the ASCA said in a released statement.
William Prentice, CEO of the ASCA, said, "The Centers for Medicare & Medicaid Services’ failure to take any action to address the growing discrepancy between ASC and hospital outpatient department payments in this proposed rule demonstrates why enactment of the Ambulatory Surgical Center Quality and Access Act of 2013 (S. 1137/H.R. 2500) is so important. If we can’t get a regulatory fix for this problem, we need to continue to pursue a solution in Congress."
These additional changes were included in the proposal:
• Four additional quality measures proposed for ASCs.
CMS is proposing the following measures, which will affect payment in CY 2016, with data collection beginning in CY 2014:
- complications within 30 days following cataract surgery requiring additional surgical procedures;
- endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients;
- endoscopy/polyp surveillance: colonoscopy interval for patients with a history of adenomatous polyps — avoidance of inappropriate use;
- cataracts: improvement in patient’s visual function within 90 days following cataract surgery.
• Small facility quality reporting exemption proposed for ASCs.
CMS has proposed a minimum case threshold to exempt smaller facilities where program implementation can be overly burdensome. They have selected 240 Medicare claims per year because 10% of ASCs have fewer than 240 Medicare claims per year, so this policy would exempt only those ASCs with the fewest number of Medicare claims, the ASCA says.
• No new procedures proposed for ASCs.
The agency has not proposed to add any procedures to the ASC list of payable procedures for 2014.
• Ending the direct supervision enforcement delay for critical access hospitals and small rural hospitals on Dec. 31 proposed.
This item was strongly opposed by the American Hospital Association (AHA).
• Creating 29 comprehensive ambulatory payment classifications (APCs) to replace existing device-dependent APCs proposed.
Additionally, without congressional action, the Physician Fee Schedule rule would reduce Medicare physician payments by an estimated 24.4% on Jan. 1, the AHA says.
Comments are due to CMS by Sept. 6, and final rules are expected by Nov. 1, according to the AHA. The proposed rule appeared in the July 19, 2013, Federal Register and can be downloaded from the Federal Register at http://1.usa.gov/14H179J.
