CMS 2018 final payment rule increases ASC reimbursement 1.2%, less than proposed: 5 things to know

CMS released the 2018 final payment rule for ASCs and hospital outpatient departments, both of which received lower reimbursement increases than proposed in July, according to ASCA.

 Here are five things to know:

1. ASC payment rates will increase 1.2 percent in 2018 based on a projected inflation of 1.7 percent, minus a 0.5 percentage point productivity adjustment required by the ACA. The adjustment falls short of the 1.9 percent proposed increase in July.

The percentage increase varies by procedure, but the average update for ASCs is 1.2 percent.

2. HOPDs received a 1.35 percent increase in reimbursement, based on a 2.7 percent market basket update minus a 0.6 percent adjustment for economywide productivity, as well as a 0.75 percentage point adjustment, which is required by statute. In July, the proposed payment rule would have increased HOPD pay 1.75 percent.

3. ASCs and HOPDs are updated based on two different inflationary factors, which accounts for a portion in the reimbursement gap between the two settings. "Yet again, ASC payments fall farther behind those of hospital outpatient departments because CMS continues to use an inflation factor — the CPI-U — that doesn't focus on the cost of goods and services in the healthcare market," said ASCA CEO William Prentice. "CMS insists on waiting for a perfect replacement to the CPI-U while a good one, the hospital market basket, is available."

4. CMS added three new procedures to the ASC payable list: cervical artificial discectomy, second level cervical discectomy and total laparoscopic hysterectomy of the uterus over 250 grams. The agency removed total knee replacements from the inpatient-only list and plans to examine other joint replacement codes for removal in the future.

However, CMS continues to exclude total knee and hip replacements as well as partial hip replacement from the ASC payable list because, as described by CMS, "our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure."

5. For 2018, CMS updated the ASC Quality Reporting Program to include:

• A delay for the mandatory Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey implementation under the ASCQR Program for 2018 data collection.
• The removal of three measures from the 2019 payment determination, including ASC-5: Prophylactic Intravenous IV Antibiotic Timing; ASC-6: Safe Surgery Checklist Use; and ASC-7: ASC Facility Volume Data on Selective Procedures.

CMS finalized two measures that are collected through claims for 2022 payment determination and subsequent years. Those measures are ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures and ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures.

CMS did not finalize ASC-16: Toxic Anterior Segment Syndrome for 2021 and subsequent years payment determination.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast