Hospitals' bottom lines possible motivator for CMS changes, consultant says

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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 she thinks CMS removed procedures from the outpatient list because hospitals are worried about their bottom lines.

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

Question: What's driving the CMS approved procedures changes?

Naya Kehayes: There was this response from the hospitals and other stakeholders on this proposed rule that may have motivated CMS to propose both the removal of the ASC codes as well as reestablishing the inpatient only list, which is the second component.

I think that there's probably been a lot of feedback from the hospitals and health systems with concerns about the magnitude of cases that potentially could come out of hospitals. With the financial implications, it could be devastating for many hospitals. When we look at surgical record migration analyses on ASC-eligible codes from a hospital, it's significant. It can be 60 to 80 percent. 

And so when you look at that magnitude of volume, I'm sure many hospitals are concerned about their financial viability and are expressing those concerns to CMS. And we certainly need hospitals to provide care to those patients that need to be in the hospital. And if they don't,  if they're at risk to lose significant volumes, that could absolutely be a major financial hit to them and could be devastating.

So I think that's part of it. And I also think last year was one of the biggest approved lists of codes ever for ASCs. Looking deeper at it, it doesn't actually surprise me a bit because some of these are really big cases. But I don't think there was really a methodical process that went into reviewing what the implications are, because there's not enough data.

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