CMS adds 14 procedures, but cuts other payments

In a proposed regulation, the Centers for Medicare & Medicaid Services (CMS) is adding 14 procedures to the approved list for ambulatory surgery centers (ASCs) in 2007 (see list) and plans to expand the list further in 2008.

"I'm extremely disappointment that lap chole isn't on here," says Kathy Bryant, president of FASA. Despite that disappointment, she acknowledges that she is pleased CMS moved ahead with the list update despite the fact that the entire system is changing in 2008. The expansions in the ASC list go a long way to making ambulatory surgery services more available to Medicare beneficiaries, she says. "They went forward without the [General Accounting Office] report, now 18 months overdue, so we can comment and work on the problems," Bryant says.

Craig Jeffries, executive director of the American Association of Ambulatory Surgery Centers in Johnson City, TN, said in a prepared statement that beneficiary access to ASCs is "modestly improved" with the limited expansion of procedures that would be covered in the ASC setting. "However, the proposed rule falls short of providing Medicare beneficiaries with the range of safe choices available in the commercial insurance market by continuing to impose a regulatory approach instead of relying on the judgment of the physician in consultation with their patient to choice a surgery setting," he said.

The proposed calendar year 2008 expansion of the ASC list includes 750 more procedures, two-thirds of which are currently performed mostly in physician offices. Bryant says, "In general removing arbitrary restrictions on what procedures that can be paid for ASCs in is a positive step. However, because of special payment limits and budget neutrality, the impact of added procedures needs to be carefully evaluated before the impact on ASCs can be assessed."

If the proposed rule for hospital outpatient departments (HOPDs) is adopted, then the ASC payment rate for 274 procedures will be reduced, Bryant says. This reduction is a result of a law passed by Congress in 2006 that limits the maximum ASC payment rate for any procedure to the HOPD payment rate for that same procedure.

"Our beef with that one is with Congress," Bryant says. "We don't like it."

Beginning in calendar year 2008, payment for office-based surgical procedures would be limited to the lesser of the Medicare Physician Fee Schedule nonfacility practice expense payment or the applicable ASC rate. Office-based procedures that are on the ASC list as of Jan. 1, 2007, would be exempt from the payment limitation.