'It's an obvious step backwards': ASC execs pan CMS' 2022 proposed pay changes

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ASC owners and executives are critical of CMS' plan to cut procedures from the ASC payable list and add several surgeries back to the inpatient-only list after removing them in January.

"It’s an obvious step backwards," said Gabriel Figueroa, administrator of Manhattan Reproductive Surgery Center in New York City. "It brings into question so many factors within the decision-making process at CMS. If the real reason for what seems like indecisiveness is truly patient safety, then what was the process of evaluating the procedures to decide that they were appropriate for the ASC? That needs to be looked at, assessed and be as transparent as possible."

CMS on July 19 released the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System proposed rule, noting the agency received several comments concerned about patient safety if it moved forward with the 2021 final rule, which set a timeline for eliminating the inpatient-only list by 2023.

"Removing the IPO list in its entirety at the onset of this issue in the previous presidential administration could be viewed as excessive," said Christina Holloway, administrator of ASC Bala Cynwyd (Pa.). "There are many procedures listed that would be inappropriate to consider without intensive monitoring and higher level of care, which automatically negates the outpatient market from being a viable healthcare option, such as open treatment of complicated craniofacial separation with fixation devices. In the same note, there are many procedures in the current ASC list set to return to the IPO in 2022 that have proven to be successful and well controlled for patients with minimal comorbidities. We should also be cognizant of the unknowns in ebb and flow of the COVID-19 variants currently invading the population as we potentially move forward with unnecessary limitations in outpatient care."

Some ASC administrators are questioning the validity of CMS' swift change and motives.

"How much clinical data was gathered and analyzed in a year's time, considering the COVID-19 pandemic when many ASCs were limited in the surgery and procedures they were allowed to perform, to come to the decision that these procedures are unsafe in the ASC?" Mr. Figueroa said. "The adding and/or removing of procedures has serious potential ramifications to the ASCs that chose to add these procedures in terms of new equipment and instrumentation purchases, training of staff and physician recruitment, to just name a few."

CMS proposed removing several heart, spine, general surgery and urology procedures from the ASC payable list. Click here for the full list of procedures that would be cut.

"This sounds like a terrible idea fueled by some backroom politics between hospital executives and the government," said Richard Rosenfield, MD, executive medical director and chief of gynecology at Pearl Women's Center and Pearl Surgicenter in Portland, Ore. "Unless there is solid data to support this movement, it is a clear move by hospitals to protect revenue more so than ensure safety."

Craig Gold, PsyD, administrator of Virginia Center for Eye Surgery in Virginia Beach, said he feels CMS has an obligation to provide more transparency into the decision-making process when updating the inpatient-only and ASC payable lists.

"Some ASCs may make significant capital investments to begin performing newly added procedures, and to have those then removed a year later can impact their bottom line," he said. "Additionally, it may make ASCs reluctant to move forward with performing newly added procedures in the future."

The chilling effect of these policy changes could add costs back into the healthcare system. ASCs charge lower overall rates for surgery than hospitals, so it could cost Medicare millions of dollars if ASCs are unwilling to support future procedures added to the ASC payable list.

"As ASC reimbursement is less than hospital reimbursement, the cost savings to the medical system — and Medicare in particular — would have been quite significant for these surgeries," said Dan Byck, MD, of Utah Orthopaedics. "This is clearly a backwards move by CMS on many fronts. I would be very interested in hearing the rationale and what pressure was brought to bear on CMS to reverse itself."

Karen Bewer, RN, administrator of Pain Physicians of Wisconsin in Milwaukee, said she would support moving procedures off the ASC payable list if there was good evidence that surgery centres had more complications and if the data was risk adjusted.

"I would be very interested in hearing more about the changes and would be on board to continue studying a [removed] procedure with the goal of getting it back to the ASC, if that was the issue," she said.

The solution may be in closing the gap between ASC and hospital outpatient department payments. CMS did continue its plan to increase ASC pay next year based on the projected hospital market basket increase, continuing a five-year exploratory period with the payment system that began in 2019.

"I wish CMS would have a site-neutral payment plan and not look at whether a procedure is in a hospital or an ASC," said Cathy McCue, MSN, RN, administrator of UroPartners Surgery Center in Des Plaines, Ill. "In the end the ASC gets the better end of the deal with increased payments."

 

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