Trade groups for hospitals and ambulatory surgery centers agree that the payment system for ASCs needs to change, but don’t see eye to eye on how that system should be implemented.
At issue is a final rule expected out this summer that would expand upon Medicare payment categories and types of procedures that could be performed at ASCs—barring certain exclusions—and to base payments for ASCs on the same methodology for hospital outpatient departments.
The matter has attracted interest from federal legislators, with two U.S. representatives recently introducing a bill that overwrites some of the proposals from the CMS on how to change ASC reimbursement.
Currently, ASC payments are getting squeezed into nine categories, says Ellen Pryga, director of policy for the American Hospital Association. “They need a more granular system of payment,” which the CMS offered to provide in proposing 450 new categories in its proposed rule, she says. However, “in throwing the door open wide” to allow ASCs to conduct more procedures, the CMS has done nothing to ensure that these procedures would be safe for beneficiaries, she says.
In addition, standards for ASCs haven’t been updated since the '80s, Pryga says. Still, the ASCs have yet to “cough up any cost data” that could help determine appropriate levels of payment for their industry, she says.
The American Association of Ambulatory Surgery Centers believes the CMS proposal sells its members short, and is endorsing legislation that it believes would do a better job to adequately pay ASCs and improve care to beneficiaries. Setting payments for ASCs at 62% of the outpatient rate, as the CMS proposed, would be a significant reduction from what some ASCs are now getting paid under Medicare, says Craig Jeffries, executive director of the AAASC.
A bill recently introduced by Reps. Kendrick Meek (D-Fla.) and Wally Herger (R-Calif.) underscores “what the CMS needs to include in the final rule,” Jeffries says. The Ambulatory Surgical Center Payment Modernization Act would set ASC reimbursement rates for Medicare at a more generous rate than the CMS proposed—at 75% of the hospital outpatient department rates—and tie the inflation factor used to update hospital outpatient payment rates to ASC payments. This means that Medicare patients would get a 25% discount on what they would ordinarily pay for the same procedure in the hospital outpatient department.
While the CMS would set certain exclusions for the types of surgical procedures ASCs could perform, the bill “sets no limitations” at all, except to say that ASCs would be able to conduct the same types of procedures as hospital outpatient departments, unless HHS deems otherwise, Pryga says.