Federal Government Affairs News and Notes:

Friday, October 27, 2023 10:28 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:

  • The House Energy & Commerce Health Subcommittee held a legislative hearing to discuss 23 bills and drafts that would reform how Medicare pays healthcare providers. There was a bipartisan consensus that physicians are paid inadequately to keep pace with inflation and rising practice expenses. They also mentioned how hospitals receive an annual inflationary update, but physicians do not. The discussion specifically touched on increased consolidation flaws with the Merit-Based Incentive Payment System (MIPS), alternative payment models, unworkable administrative burden and prior authorization, and the need for site-neutral payments. Unfortunately, the Committee did not consider the copay cap issue of our bill in time for this hearing.  Witnesses for the hearing included the Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), the American Academy of Family Physicians (AAFP), Texas Oncology, and other healthcare think tanks, which testified on reforming the Medicare Access and CHIP Reauthorization Act (MACRA) and ensuring that appropriate reimbursement for doctors occurs. Democrats acknowledged the importance of improving the healthcare physician reimbursement system but criticized bills without very much Democratic influence.

  • ASCA expects the Centers for Medicare & Medicaid Services (CMS) to release the CY 2024 OPPS/ASC Final Rule next week. ASCA will send an initial alert on the day of the rule release and will follow up with additional information.

  • On October 12, ASCA representatives met with Doug Jacobs, MD, chief transformation officer in the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS). ASCA requested the meeting to discuss the 2024 proposed payment rule for ASCs and hospital outpatient departments (HOPD), which was released on July 13.
    • ASCA Chief Executive Officer Bill Prentice began the call by expressing disappointment with CMS’ lack of transparency regarding additions to the ASC Covered Procedures List (ASC-CPL). Although ASCA provided a list of 63 codes for procedures that are being performed safely in ASCs on non-Medicare populations to be added to the ASC-CPL, CMS added only one of the requested codes—G0330 (Facility svs dental rehab)—as part of a larger policy change that includes the proposed addition of 26 dental surgical codes. CMS provided no comment on the lack of inclusion of the other surgical codes ASCA proposed for addition to the ASC-CPL, which included total shoulder arthroplasty (TSA).

    • David Weinstein, MD, ASCA Board member and orthopedic surgeon with the Surgical Center of the Rockies in Colorado Springs, Colorado, joined the call to discuss TSA (CPT 23472). He expressed confusion as to why his colleagues performing total knee and hip arthroplasties are allowed to do so on the Medicare population while he is not allowed to perform TSA on the same population. Dr. Weinstein mentioned research indicating the stellar outcomes when TSA is performed in the outpatient setting, which is supported by his own experiences performing TSA in the ASC setting. According to CMS Physician/Supplier Procedure Summary (PSPS) data, there were 36,159 TSAs performed on Medicare fee-for-service (FFS) beneficiaries in HOPDs in 2021.

    • Since the final rule is due for release within the next two weeks, CMS staff is limited as to how much they can engage in dialogue at this time. However, the meeting allowed ASCA staff to introduce themselves to Dr. Jacobs and highlight some of their formal comments submitted in response to the proposed rule. Once the final rule is released in early November, ASCA will request a meeting to discuss 2025 rulemaking.

Association of Wisconsin Surgery Centers
563 Carter Court, Suite B Kimberly WI 54136
920-560-5627 I WISCA@badgerbay.co

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