CMS Releases Disappointing Final CY 2016 ASC Payment Regulation

On October 30, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2016 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). The highlights for ophthalmic ASCs:

2016 ASC Payment Rate Update. ASC payments are annually updated for inflation by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U) less a multifactor productivity (MFP) adjustment. For CY 2016, the CPI-U update is 0.8 percent and the MFP adjustment is 0.5 percent, resulting in a 2016 ASC update factor of 0.3 percent. The following are final 2015 rates for several high-volume ophthalmic procedures.

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ASC Quality Reporting. OOSS, AAO, ASCRS, and the ASC Quality Collaboration are in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency has solicited comments on one such measure, Unplanned Anterior Victrectomy, which would assess the percentage of cataract patients who have the procedure in the ASC. CMS has announced that it will consider industry comments in determining whether and when this important measure should be implemented.

Corneal Tissue. CMS has finalized its proposal that, effective CY 2016, separate payments to ASCs and HOPDs for corneal tissue acquisition costs would be limited to tissue used in the corneal transplant procedure and not for non-transplant procedures. The agency has clarified that it will make packaged payments for all tissues used for patch grafts in glaucoma shunt surgery.

As in recent years, we are disappointed but not surprised by CMS’ decision not to update ASC payment rates by the higher Hospital Market Basket used for purposes of HOPD payments. OOSS’ position is very simple: ASC payment rates should be updated annually by the same factor used to update hospital rates — the Hospital Market Basket. We will continue to make our case at CMS for appropriate modifications to the rates and to the ASC Quality Reporting Program and the policies underlying them. OOSS will also continue to seek enactment of legislation in the new Congress that will make necessary systemic reforms to the payment system.

OOSS will keep you abreast of further developments. Should you have any questions regarding the rule, please contact our Washington Counsel, Michael Romansky, at mromansky@ooss.org

The final ASC payment rule can be reviewed at: Final CY 2016 ASC Payment Regulation.

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