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Medicare Proposes 0.9% ASC Fee Increase, Linking Payments to Quality

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CMS has released its 2012 proposed payment rule for ambulatory surgery centers and hospital outpatient departments, which calls for a proposed ASC Medicare across the board fee increase of 0.9 percent beginning Jan. 1, 2012, and the establishment of a requirement for ASC quality reporting, according to an ASC Association news release and CMS.

 

CMS continues to base its proposed ASC inflation update on the Consumer Price Index for All Urban Consumers (CPI-U) rather than the hospital market basket on which hospital outpatient departments have their updates based. HOPDs are scheduled to get a 1.5 percent fee increase.

 

ASCA expressed its disappointment with the continued reliance on the CPI-U to update ASC payments, stating the hospital market basket is a more appropriate measure of inflation for ASCs and has typically been higher than the CPI-U.

 

The change in the Medicare reimbursement rates for individual procedures performed at individual ASCs will vary from the 0.9 proposed increase due to other factors such as the change in the relative costs of the procedures and changes in wage index values. For example, CMS estimates payments for HCPCS 66984 (Cataract surg w/iol, 1 stage) would have an estimated 2012 percent change of 0 percent, HCPCS 43239 (Upper GI endoscopy, biopsy) would decrease 3 percent and HCPCS 45380 (Colonoscopy and biopsy) would increase 2 percent.

 

The proposed rule would for the first time establish a voluntary, confidential quality reporting program for ASCs. CMS is proposing eight quality measures for reporting, including seven outcome and surgical infection control measures, which include the six measures developed by the ASC Quality Collaboration, and one healthcare associated infection measure reported through the National Healthcare Safety Network. In the future, CMS is proposing to reduce payment rates for ASCs that fail to report required quality measures.

 

Comments are due by Aug. 30; final rules should come out Nov. 1.

 

Read more on the proposed rule from the ASC Association.

 

Read the CMS news release on the 2012 Medicare proposed rule.

 

View the Medicare proposed rule (pdf).

 

More Articles Featuring the ASC Association:

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ASC Association Submits Comments on Proposed ACO Rule

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