On July 3, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2015 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). The proposal regulation will soon be published in the Federal Register, after which time OOSS and other interested parties will have an opportunity to submit public comments.
Below please find a brief summary of key components of the proposed rule. A more detailed summary with proposed payment rates of representative ophthalmic surgical procedures will be provided shortly. OOSS will provide you with the rates for specific procedures as soon as the data is made available.
CY 2015 Payment Rates
Under the ASC payment system, facilities receive a percentage of the relative weight assigned to a code for procedures furnished in HOPDs. The relative weights are re-calibrated each year based on a complex formula that takes into account a number of factors, including changes in hospitals’ costs in providing such services and the mandate that the ASC payment system remain budget-neutral.
Again this year, the 2015 proposal contemplates an inflation update for ASCs; CMS is providing an update based upon the Consumer Price Update –Urban (CPI-U), which the agency estimates to be 1.7 percent. However, most health care providers will incur a “productivity adjustment” against their cost of living updates; CMS estimates that this adjustment will be 0.5 percent, which would result in a 2015 ASC positive payment rate of 1.2 percent. Although the government has once again rejected the ASC community’s recommendation that facilities be paid on the basis of the same update factor provided hospital outpatient departments, the agency has acknowledged that the CPI-U may not be the best inflator for ASCs. OOSS and the ASC and ophthalmology communities will continue to vigorously lobby for the higher Hospital Market Basket update factor to be applied to ASCs.
ASC Quality Reporting
Effective October 1, 2012, facilities commenced reporting data with respect to the following measures: patient burns; patient fall in the ASC; wrong site, wrong side, wrong patient, wrong procedure, wrong implant; hospital transfer/admission; and, prophylactic IV antibiotic timing. As discussed in prior Updates Online, facilities are also required to report through CMS’ Quality Net website data with respect to procedure volume and use of a safe surgery checklist.
You will recall that last year CMS proposed that, effective in 2014, ASCs report on Measure ASC-11/NQF 1536, Improvement in Patient’s Visual Function Within 90 days Following Cataract Surgery. Facilities would have provided aggregate data on this chart-abstracted measure via the Quality Net web portal. Based upon the lobbying efforts of the ASC and ophthalmology communities and citing “operational difficulties,” CMS delayed the effective data of the measure to January 1, 2015. We are pleased to report that CMS has decided to transition ASC-11/NQF-1536 from mandatory to voluntary reporting. As such, our centers will not be required to collect and submit data on this measure.
OOSS and the ophthalmology and ASC communities are in the process of developing and proposing new and appropriate ophthalmic ASC measure. We remain vigilant in our position that any ASC quality measure should relate to the episode of care within the ASC, encompass data that is available within the ASC, be collectable by ASC staff, produce conclusions that are actionable by the facility and have been tested on a pilot basis in the ASC.
New Technology Intraocular Lens (NTIOL) Payment
ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS has adopted changes in the standards through which it reviews NTIOL applications, requiring that as a condition to a lens being eligible for NTIOL status that the FDA approved labeling for the product contain a claim of a specific clinical benefit imparted by a new lens characteristic. CMS reports that there were no applications submitted by ophthalmics manufacturers requesting NTIOL status for lenses for the 2015 ASC payment rate rulemaking.
OOSS Action on this Rule
We are disappointed, but not surprised, by CMS’ effort to update payment rates. OOSS will submit comprehensive comments on these and other issues. We will alsoask you, the OOSS member, to submit comments this summer to CMS on both payment and quality reporting issues and will provide you with all the tools to do so.
The proposed regulation (CMS-1589-P) can be reviewed at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-15939.pdf.
OOSS will keep you abreast of further developments as well as instructions for OOSS members to submit public comments on the proposed regulation. Should you have any questions regarding the rule, please contact Michael Romansky, JD at mromansky@OOSS.org.