CMS has proposed adding more than 600 procedures to the ASC-covered procedures list, with final rules expected in November. But eligibility and financial viability are different questions.
For ASC operators, the more pressing issue is whether the reimbursement attached to those procedures is enough to make offering them worthwhile, and for many, the answer will be no.
Three surgeons recently connected with Becker’s to break down which new procedures they’d realistically adopt and which they’d pass on.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Which of these new procedures on CMS’ proposed list would your ASC or facility realistically take on, which would you decline and what would need to change in reimbursement for that to shift?
John Abrahams, MD. Spine Surgeon at New York Brain & Spine Surgery (Harrison): Reducing the fee schedule for pain management procedures will be a continued tactic by Medicare. As procedures move out of the hospital to ASCs because of high costs, they will move from ASCs to Quad A facilities in the outpatient office space for the same reason.
What was routine in a hospital will need to move to high-volume ASCs, but the problem is that there are a number of ASCs that were built, sold to a larger partner and then saw a volume decrease as the founding surgeons and proceduralists move on to other ventures.
Private equity has not been successful either as they acquire the ASC but do not have the outcome data to warrant better reimbursement rates.
Ernest Braxton, Jr., MD. Partner and Neurosurgeon at Vail (Colo.) Summit Orthopaedics & Neurosurgery: Our ASC would realistically take on the newly added procedures that have predictable recovery, low complication risk and a clear same-day or overnight pathway, including many spine and musculoskeletal cases we already perform safely in appropriately selected patients. Where we would decline, or at least hesitate, is implant-driven surgery such as multilevel fusions and complex reconstructions, where the cost of interbody devices, screws, plates and biologics can approach or exceed the entire ASC payment. Adding a code to the covered list does not make it viable if the facility loses money every time the case is scheduled.
For that to shift, CMS needs to assign device-intensive procedure designation to the implant-related procedures it is adding, so the device portion of the payment reflects actual implant cost, ideally on par with how hospital outpatient departments are reimbursed for the same devices. Without that, patients who are excellent candidates for ambulatory surgery will continue to be directed to the hospital.
Don Brown, DO. Vascular Surgeon and Owner of Southern Kentucky Vascular ASC (Somerset): The Detour endovenous percutaneous system is a newer system for bypassing blockages in the femoral and popliteal arteries. For patients who lack a venous conduit option or who are too ill for general anesthesia, this system provides a viable alternative. Esprit Bioresorbable scaffolds are resorbable stents used to open arteries in the tibial vessels typically for chronic limb-threatening occlusive disease.
These days, getting hospital approval for new products is difficult. Often, we only get a single-use approval, requiring us to ask for permission every time. This delay and frustration often slow the care our patients need. Being able to use the Detour system in our ASC will help mitigate this. Without the CMS payments, it would be impossible financially to use this in the outpatient setting. The Esprit stents are available in the office-based lab setting, but can be cost prohibitive for many. Having a pass-through code for our ASC requires a little extra paperwork for our billing department, but it is worth it.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
