ASCs to receive 2.1% increase in 2019 Medicare reimbursement: 6 things to know

CMS released the 2019 final payment rule for hospital outpatient surgery departments and ASCs, including an average rate adjustment on procedures, according to a statement from the Ambulatory Surgery Center Association.

Here are six things to know:

1. ASCs will receive a 2.1 percent reimbursement rate increase on average per procedure. HOPDs will receive a 1.35 percent average rate increase next year. "I think these changes will incentivize physician owners to bring more Medicare cases to the ASC, particularly device-intensive procedures," said William Prentice, CEO of ASCA.

2. Device-intensive procedures are now defined as those with a "device offset percentage greater than 30 percent based on the standard OPPS APC rate-setting methodology." This is down from the pervious threshold, which was 40 percent. 

3. CMS reviewed several codes that were added to the ASC payable list over the past three years and has decided to keep the codes, including some spinal procedure codes, on the ASC payable list. ASCA expected these codes to remain on the list, which will allow surgeons to continue performing them at ASCs.

4. CMS will now make separate payments for non-opioid pain management drugs for ASCs. The only HCPCS code falling into this category is Exparel, which will now receive separate payment when used in the ASC.

5. The definition of "surgery" expanded under the ASC payment system to include select "surgery-like" procedures, such as 12 cardiac catheterization procedures. The agency added five additional cardiac catheterization procedures to the ASC covered list as well.

"As ASCs continue to show the ability to safely migrate more commercial procedures, we expect CMS to respond appropriately and expand the list of reimbursable procedures for Medicare beneficiaries," said Mr. Prentice. "This definitional change will allow surgery centers with the right expertise to perform these procedures, with great savings for the Medicare system."

6. Two of the eight measures CMS proposed to remove from the quality reporting program were approved. Beginning in 2020, CMS will remove "ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel," and in 2021 remove, "ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use."

The agency left ASC-1, 2 and 3 on the list but suspended data collection for them until the measures could be revised. "The reduction of measures in the ASC Quality Reporting Program demonstrates the outstanding performance of ASCs in preventing serious adverse events. We look forward to working with CMS staff to identify actionable quality data that can be used by patients, providers and regulators," said Mr. Prentice in the AWSCA statement.

While many of these changes are positive for ASCs, ASCA will continue advocating for beneficial changes. "As great as the payment policy changes in this rule are, we know there are additional incentives in terms of payment policy that could dramatically increase procedure migration and bend the cost curve for Medicare," said Mr. Prentice. "We look forward to working with CMS on those in 2019 and beyond."


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