Federal Government Affairs News and Notes:
WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest government affairs news from ASCA:
- CMS Releases 2023 Proposed Medicare Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2023 proposed payment rule for ASCs and hospital outpatient departments (HOPD) on July 15, 2022.
CMS proposed to continue to align the ASC update factor with the one used to update HOPD payments. Under the proposal, CMS would continue to use the hospital market basket to update ASC payments for calendar year (CY) 2023 as the agency assesses this policy’s impact on volume migration. This will be the last year of the trial period.
If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.7 percent, which is a combination of a 3.1 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.4 percentage points. This is an average and the updates might vary significantly by code and specialty.
In addition, although ASCA provided a list of 47 codes for procedures that are being done safely on non-Medicare populations for consideration to be added to the ASC Covered Procedures List (ASC-CPL), CMS added only one of the requested codes: 38531 (Open bx/exc inguinofem nodes).
“This proposed rule misses an opportunity to lower costs and improve access to care to beneficiaries by not adding many viable procedures that ASCs are safely performing on commercial patients,” says Bill Prentice, chief executive officer of ASCA. “We have provided clinical data to CMS that should be used to add these procedures to our allowable list for 2023.”
The payment rule proposals include:
- An update to the ASC conversion factor using the hospital market basket. The new conversion factor would be increased by 2.7% for facilities that meet the quality reporting requirements.
- An update to the ASC Relative Payment Weights for CY 2023, which includes an ASC weight scalar of 0.8474.
- Changes to the Inpatient Only (IPO) List, which would remove ten codes from the IPO list for 2023.
- The addition of one code to the ASC-CPL for 2023 (38531 – Open bx/exc inguinofem nodes).
- ASCA seeks outcomes data to represent the safety and quality care of ASCs. CMS indicated that they would not add additional codes without this data.
- A name and start date change for the nomination process. The name change would switch from “Nominations” to the “Pre-Proposed Rule CPL Recommendation Process.”
- The nominations process start date is revised to January 1, 2024.
- A complexity adjustment that adds 52 new C codes to the ASC-CPL. This would create a special payment policy for code combinations that result in more complex and costly procedures, similar to the complexity adjustment currently available in the Outpatient Prospective Payment System (OPPS).
- An ASC payment system policy for non-opioid pain management drugs and biologicals that function as surgical supplies.
- The delay of ASC-11 Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataracts Surgery and the continuation of voluntary reporting for the measure. There is also a proposal to adopt a volume indicator such as ASC-7 potentially, and there were no changes made to ASC-20 COVID-19- Vaccination Coverage for Healthcare Personnel.
- A Request for Information about using CMS data to drive competition in healthcare marketplaces.
CLICK HERE to review the full rule and HERE for the rule analysis.
ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.
Every year, National ASC Month is celebrated in August to highlight the achievements of ASCs across the country, coinciding with Congress’s long August recess. If your ASC is interested in hosting a facility tour for your member of Congress, please complete ASCA’s Facility Tour Interest Form or visit ASCA’s facility tour webpage for more information. In addition, you can also contact the WISCA office at WISCA@badgerbay.co to set up a legislative tour of your ASC with either your member of Congress or local state legislators. In fact, WISCA recently coordinated a tour of the Northwoods Surgery Center in Woodruff, WI with Congressman Tom Tiffany, State Senator Mary Felzkowski, and State Representative Rob Swearengen.