Federal Government Affairs News and Notes:

Friday, July 28, 2023 9:26 AM | WiSCA (Administrator)

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 federal government affairs news from ASCA:

·         OPPS/ASC Proposed Payment Rule
On Thursday, July 13, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments. Please find the highlights below:

  • Update Factor: CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025.
    • If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.8 percent, which is a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2 percentage points. This is an average, and the updates might vary significantly by code and specialty.
  • ASC-CPL: ASCA has been working with national dental organizations to add dental procedures to the ASC Covered Procedures List (ASC-CPL), and CMS proposed adding 26 dental surgical codes for 2024.
    • Unfortunately, although ASCA provided a list of 62 other surgical codes being performed safely in ASCs on non-Medicare populations to be added to the ASC-CPL, including total shoulder arthroplasty, CMS declined to add these codes.
  • ASC-11: CMS proposes modifications to ASC-11: Cataracts Visual Function (previously referred to as Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery), but the measure remains voluntary at this time.

  • ASCQR Program: Regarding the ASC Quality Reporting (ASCQR) Program, CMS is proposing to readopt with modification ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures, with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period.

  • ASC-21: CMS is also proposing to adopt ASC-21: Risk-Standardized Patient-Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the ASC Setting (THA/TKA PRO-PM), with voluntary reporting beginning with the CY 2025 and 2026 reporting periods followed by mandatory reporting beginning with the CY 2027 reporting period.

  • ASC-20: Unfortunately, ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel is proposed to remain in the ASCQR Program, with some modifications. ASCA will continue to oppose this burdensome measure.

·         MPFS Proposed Rule
CMS also released proposed 2024 updates to the Medicare Physician Fee Schedule (MPFS). Although this rule doesn't affect ASC reimbursement, ASCA does comment as PFS policy updates affect the clinicians that work in ASCs. In the proposed rule, clinicians would see a 3.36% decrease to the physician conversion factor.

Association of Wisconsin Surgery Centers
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