CMS Final Rule Increases ASC Payment Rates by 1.6% in 2012, Establishes Quality Reporting Program

The Centers for Medicare & Medicaid Services issued a final rule with comment period today that will update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments and surgery centers beginning Jan. 1, 2012, according to a CMS release.

In addition to establishing payment rates for calendar year 2012, the final rule expands the measures to be reported under the Hospital Outpatient Quality Reporting Program, creates a new quality reporting program for surgery centers and strengthens the Hospital Value-based Purchasing program that will affect inpatient payments starting Oct. 1, 2012.

CMS projects that payments to approximately 5,000 Medicare-participating ASCs under the ASC Payment System will be approximately $3.5 billion for CY 2012. Payments to more than 4,000 hospitals paid under the Outpatient Prospective Payment System in CY 2012 will total around $41.1 billion.

The final rule increases payment rates to ASCs by 1.6 percent in CY 2012. This increase reflects a consumer price index for all urban consumers estimated at 2.7 percent, minus a 1.1 percent productivity adjustment required under the federal healthcare reform law.

The final rule also establishes a quality reporting program for surgery centers and adopts five quality measures, including four outcome measures and one surgical infection control measure beginning in CY 2012 for the CY 2014 payment determination. The final rule also adds two structural measures for reporting beginning in CY 2013 for the CY 2015 and CY 2016 payment determinations. One applies to safe surgery checklist use and one applies to ASC facility volume data on selected surgical procedures. 

In response to the release of the final rule, the ASC Association said it was "disappointed that, despite ASCA's objections, CMS continues to use a flawed measurement (CPI-U) in setting the ASC rates." The association further stated it was "pleased that the anemic 0.9 percent that had been initially proposed has grown to 1.6 percent in the final rule." The association was also pleased that CMS addressed concerns about quality reporting requirements, specifically the suggestion that a start date of Jan. 1 was impracticable.

Access the final rule here.

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