ASCA CEO Bill Prentice: ASC payments will rise 2.7% if CMS goes through with proposal

If CMS' 2020 proposed payment rule for ASCs and hospital outpatient departments is finalized as written, ASCs could see an average 2.7 percent payment increase over all covered procedures, according to ASCA CEO Bill Prentice.

Four takeaways he shared:

1. ASC payment updates. CMS proposed continuing to use the hospital market basket to update ASC payments. Mr. Prentice predicts this would drive a 2.7 percent payment increase for ASCs, which includes a 3.2 inflation update based on the hospital market basket plus a 0.5 percent productivity reduction per the Affordable Care Act.

"It is important to remember that the 2.7 percent increase is an average that will not apply equally to every procedure ASCs perform, so updates might vary significantly by code and specialty," Mr. Prentice said. "Also, this proposed update does not take into consideration sequestration, which reduces ASC payments by 2 percent each year until at least 2024 unless Congress acts."

2. ASC-payable list additions. Mr. Prentice commended CMS' proposals to add total knee arthroscopy and several cardiac procedures to the ASC-payable list, as well as the agency's proposal to move total hip arthroplasty off the inpatient-only list.

Although ASCs won't be reimbursed for THA involving Medicare beneficiaries in 2020, "given the excellent outcomes privately insured patients are already experiencing with those procedures in the outpatient setting and how quickly Medicare moved total knees from the HOPD setting into ASCs, we are hopeful that total hips will be approved for ASCs in the near future," Mr. Prentice said.

3. Quality reporting measures. If the rule is enacted as proposed, Medicare's ASC quality reporting program would include ASC-19, a measure examining hospital visits within seven days of ASC-based general surgery. Notably, CMS didn't propose making the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey mandatory.

4. Price transparency. If CMS requires hospitals to publicized their negotiated rates, the requirement will likely expand to other providers in the future, according to Mr. Prentice.

"We will be paying close attention as this proposal moves forward and will keep our members apprised of all developments," he said.

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