Why restoring the inpatient-only list is good for ASCs & more wins in CMS pay proposal

CMS proposed several changes to the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System that reverse policies many considered favorable to ASCs.

If finalized, the 2022 rule would reinstate the inpatient-only list, which it previously planned to dissolve in 2024. CMS would have kept the ASC-payable list in place, so removing the inpatient-only list would not have added procedures to surgery centers outright.

"Just as the decision to eliminate the inpatient-only list had no immediate direct impact on the kind of procedures ASCs could perform, the decision to reinstate it has no immediate direct impact on ASCs either," said William Prentice, CEO of the Ambulatory Surgery Center Association. "However, if CMS does overturn last year's decision to eliminate the IPO list, some language adopted at the same time that would prohibit new procedures from moving into ASCs in the future would also be eliminated, and that would be a positive development for ASCs."

The proposed rule also removes 258 procedures added to the ASC-payable list this year, primarily cardiology, urology, general surgery and spine codes. Mr. Prentice said the association plans to request several be retained.

"Many [of those procedures] are procedures we have already demonstrated can be performed safely in ASCs and that Medicare patients would benefit from having in the ASC setting," he said.

While CMS proposed removing some procedures from the ASC-payable list, another aspect of the policy changes would improve payment for hundreds of procedures in the outpatient setting. CMS proposed granting device-intensive surgery status to procedures where the device is 30 percent of the ASC procedure rate, lowering the threshold for procedures to receive extra pay because costs for associated devices are so steep. Its current policy classifies device-intensive status as procedures where device costs exceed 30 percent of the hospital outpatient department rate, which is higher than the ASC rate.

"ASCA has long asked for adequate reimbursement of codes that involve significant device costs, and a policy in this proposed rule would more appropriately cover the costs of the devices ASC physicians often implant in patients," said Mr. Prentice. "If adopted, we expect this policy to add more than 60 device-intensive procedures to the ASC setting and provide more adequate payment for more than 440 codes."

The association has also lobbied CMS to continue its five-year trial period of using the hospital market basket as the inflation update for ASCs and hospital outpatient departments, which it plans to do in 2022.

Other big aspects proposed in the 2022 final rule include:

  • Continued coverage of nonopioid pain management drugs and biologics
  • Eliminating copays for colonoscopies that become diagnostic procedures
  • Increased quality measure reporting

Mr. Prentice said the association would push back on the CMS proposal to collect data on improvement in cataract surgery patients' visual function 90 days after surgery because ASCs aren't equipped to collect this data, which would be set to begin in 2023. The results would become part of the CMS payment determination in 2025. The association also wants to make sure the ASC community has input in any new quality reporting measures and processes.

"We are pleased to see that this proposal would continue to cover the cost of nonopioid pain management drugs and biologics, and to support continued progress toward total elimination of the patient copay for screening colonoscopies that became diagnostic procedures," said Mr. Prentice. "We are pleased to see efforts from this administration to continue a dialogue with the ASC community and others in its request for additional comments on many of the proposals this rule contains and other topics that Medicare ASC payment policy might address in the future."

Finally, CMS alluded to developing a new process for specialty societies, practicing physicians and ASC industry leaders to provide input into which procedure codes are moved to the ASC- payable list.

"We are encouraged to see that Medicare has indicated an interest in creating a clear-cut, transparent process that will allow practicing physicians and others with relevant expertise to identify new procedures they believe ASCs should be able to perform for Medicare patients," said Mr. Prentice.



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