CMS Issues 2018 ASC Payment Proposed Rule: 5 Things for ASCs to Know About

July 20, 2017

The Centers for Medicare & Medicaid Services recently issued its 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule.

It includes several proposed updates that should be interest to ASCs, including changes to quality provisions and payment rates.

Here are five of the key takeaways for ASCs to know.

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

ASCs that would like to continue to administer the survey under the voluntary national implementation would be permitted to do so in 2018.

2. Payment increase of 1.9%. CMS is proposing to provide ASCs an effective payment update of 1.9% on average for all covered procedures. Actual updates may vary by code and specialty.

3. Significant changes 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 proposing to add three measures to the ASCQR program measure set for the 2021 and 2022 payment determinations and subsequent years. The three proposed measures are as follows:

  • ASC-16: Toxic Anterior Segment Syndrome (TASS) measure. This is based on aggregate measure data collected by the ASC via chart abstraction and assesses the number of ophthalmic anterior segment surgery patients diagnosed with TASS within two days of surgery (beginning with the 2021 payment determination).
  • 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 is proposing to remove three measures for the 2019 payment determination and subsequent years. The three measures proposed for removal 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

4. Total knee arthroplasty removed from IPO. CMS is proposing to remove total knee arthroplasty from the Medicare inpatient-only (IPO) list. This list identifies procedures that are only paid under the Hospital Inpatient Prospective Payment System.

CMS is also seeking comment regarding whether partial and total hip arthroplasty should be removed the IPO list.

5. Comments on payment reform. ASC payment rates are tied to data derived from the OPPS. CMS noted that given concerns about the difference between OPPS payments relative to ASC payments (56% in 2017), CMS is soliciting comments on ways to improve payment accuracy to ASCs and on the collection of ASC cost data.

CMS will accept comments on the proposed rule until Sept. 11, 2017. It will respond to comments in a final rule on or about Nov. 1, 2017.

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