Will commercial insurers follow CMS to move ASC surgeries back to the hospital?

CMS finalized the 2022 ASC payment rules and approved procedures list on Nov. 2, with 255 procedures removed from the outpatient surgery list.

I. Naya Kehayes, principal and ASC practice leader at healthcare advising firm ECG Management Consultants, told "Becker's ASC Review Podcast" that ASCs that made operational adjustments to take advantage of the previous rules change could be in financial jeopardy.

Note: This is an edited excerpt. Listen to the full podcast episode here.

Question: Will surgery centers that already moved cases in have to move them back to hospitals? How much money is at stake? 

Naya Kehayes: I think the surgery centers that have already moved these cases are absolutely at risk to have to move them back to the hospital, especially with the Medicare population. It's amazing that they're making this recommendation when the 2021 rules have just been in place for six, seven months now.

To see this proposal revert back is really concerning, because those ASCs who have set up the programs to move the cases, they've made some capital expenditures, they've probably changed staffing structures and done a lot of things operationally to accommodate. It's definitely going to have an impact on them. I think more concerning is whether or not the commercial payers will follow suit. 

With respect to how much money is represented, there's no data out there right now. It's too soon to see how many Medicare patients the ASCs are doing on these new cases, because the Medicare reporting data is about two years old. So it's difficult to understand how much volume may have started to move with Medicare as a result of the 2021 rules that are going back.

The first thing I would advise surgery centers to do is take a look at their commercial contracts that are based on the Medicare payment system. I would be going back to the commercial payer about sharing the concerns and potentially asking them for carve-outs from the methodology, because typically if you can get the case carved out in your contract, that will keep you from potentially having an adverse effect, if that payer then converts over to the same covered procedures list as Medicare in 2022. It's going to be really important to review those contracts and address the issue with the payers.

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