ASCA disappointed with final payment rule
The Ambulatory Surgery Center Association (ASCA) expressed extreme disappointment over the final calendar year (CY) 2014 hospital outpatient and ambulatory surgery center (ASC) payment rule (CMS-1601-FC) from the Centers for Medicare & Medicaid Services (CMS).
ASC payment rates will increase by 1.2% in 2014. This increase is based on a projected rate of inflation of 1.7% minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act, according to the ASCA. This payment update is higher than the 0.9% update in the proposed rule.
"While we are pleased to see a slight increase in our payments over the proposed rule, sequestration will still result in a negative update for ASCs in 2014 unless Congress acts," said ASCA CEO Bill Prentice. "As usual, we are extremely disappointed that CMS continues to undervalue ASC payments by using the CPI-U [Consumer Price Index for All Urban Consumers] to update them, a factor that even their own actuaries believe is inappropriate. Using different update factors for ASCs and HOPDs [hospital outpatient departments] widens the gap between HOPD payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs, and increases costs to the Medicare program, its beneficiaries, and taxpayers who support the program."
Quality measures finalized
CMS also finalized three of the four new quality measures that were in the proposed rule, according to the ASC Association. The new measures, which will affect payment in CY 2016, with data collection beginning in CY 2014, are as follows:
- endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients;
- endoscopy/polyp surveillance: colonoscopy interval for patients with a history of adenomatous polyps — avoidance of inappropriate use;
- cataracts: improvement in patient's visual function within 90 days following cataract surgery.
Although the three measures were finalized, the rule indicates centers will be required to report only on a sample of cases for each measure, the ASCA said. Sampling specifications will be published later in the ASC Quality Reporting Specifications Manual on the QualityNet web site (https://www.qualitynet.org).
"We regret that CMS has rejected our very valid concerns about the new quality measures it has proposed, burdening ASCs to provide data on three measures that the facilities do not routinely possess," said Prentice.
CMS did not finalize the "complications within 30 days following cataract surgery requiring additional surgical procedures" measure that was included in the proposed rule. Thus, for now, ASCs will not be required to report this information, the ASCA said. (For more information on quality rules, see resource at end of story.)
CMS also finalized its proposal to exempt smaller facilities, defined as those ASCs with fewer than 240 Medicare claims per year, from complying with the quality reporting requirements.
Although there were no new procedures in the proposed rule, CMS did move the following four codes to the ASC setting in the final rule: 27415, osteochondral knee allograft; 27524, treat kneecap fracture; 60240, removal of thyroid; and 60500, parathy-roidectomy or exploration of parathyroid[s].
To read the fact sheet on the CY 2014 final rule with comment period, go to http://go.cms.gov/18iCoM6. The final rule with comment period and final rules appeared in the Dec. 10, 2013, Federal Register and can be downloaded at http://1.usa.gov/1d3PQW3 ation on how the final rule impacts hospitals, see story, below.)
- The Ambulatory Surgery Center Association has posted 2014 Final Rule Quality Reporting FAQs. Web: bit.ly/1bTKqhz.