CMS Issues 2018 ASC Payment Final Rule: 5 Changes to Know About

November 6, 2017

The Centers for Medicare & Medicaid Services recently issued its 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System final rule. It addresses several updates ASCs will want to understand, including changes to the Ambulatory Surgical Center Quality Reporting (ASCQR) Program and payment rates.

Here are five of the most significant takeaways.

1. OAS CAHPS implementation delay. CMS is delaying the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR program for 2018 data collection (connected to 2020 payment determination).

2. Payment increase of 1.2%. ASCs that meet the quality reporting requirements under the ASCQR Program will receive an effective payment update of 1.2% on average for all covered procedures. This increase is lower than what was in the proposed rule (1.9%). Actual updates will vary by code and specialty.

Based on this update, CMS estimates that total payments to ASCs — including beneficiary cost-sharing and estimated changes in enrollment, utilization and case-mix — for CY 2018 is approximately $4.62 billion, an increase of approximately $130 million compared to estimated CY 2017 Medicare payments.

3. Addition of two measures to ASCQR Program. The ASCQR Program is the pay-for-reporting program that requires ASCs to meet requirements or receive a reduction of 2.0 percentage points in their annual payment update.

CMS is adding two measures to the ASCQR program measure set for the 2021 and 2022 payment determinations and subsequent years. The measures are as follows:

  • ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits within seven days of an orthopedic procedure performed at an ASC (beginning with the 2022 payment determination).
  • ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits occurring within seven days of the urology procedure performed at an ASC (beginning with the 2022 payment determination).

CMS had proposed adding the “ASC-16: Toxic Anterior Segment Syndrome (TASS)” measure beginning with the 2021 payment determination, but chose not to finalize its addition.

4. Removal of three measures from ASCQR Program. CMS is removing three measures for the 2019 payment determination and subsequent years. The measures are as follows:

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: ASC Facility Volume Data on Selected Procedures

5. Total knee arthroplasty removed from IPO. CMS is removing total knee arthroplasty from the Medicare inpatient-only (IPO) list for 2018. This list identifies procedures that are only paid under the Hospital Inpatient Prospective Payment System.

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