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CMS proposes 1.9% increase in 2018 ASC pay, adding total joint replacements — 5 insights

CMS released a proposed rule that would update the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System.

Here's what you should know about the ASC related changes:

1. CMS is proposing to increase payment rates by 1.9 percent to ASCs that are meeting quality reporting requirements. CMS based the increase on the consumer price index but adjusted it in accordance with the ACA.

2. CMS estimates total payments to ASCs in 2018 would be around $4.68 billion, which is an increase of $155 million over 2017.

3. In relation to the payments, CMS is soliciting comments related to payment reform in the following areas:

  • The rate update factor applied to payments
  • How ASCs submit cost-related data
  • Whether ASCs should use an institutional claim form
  • Other ideas to improve payment accuracy

4. CMS is soliticing comments on whether three procedures should be added to the ASC covered procedures list. They are:

  • Total knee arthroplasty
  • Partial hip arthroplasty
  • Total hip arthroplasty

The agency is also seeking comments on whether there are codes not listed in the American Medical Association's' Current Procedural Terminology surgical code range that should be covered.

5. Concerning the ASC quality reporting program, the agency is proposing to adopt measures for the 2019, 2021 and 2022 payment determinations.

For 2019, CMS wants to remove:

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

Starting in 2018, CMS would expand its online tool to allow for batch submission of measure data and it would align the Extraordinary Circumstances Exceptions policy with other programs.

For 2021, CMS wants to add a measure related to toxic anterior segment syndrome. In 2022, CMS wants to add two measures related to hospital visits after both orthopedic and urology procedures.

Editor's note: This article was updated July 14.


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