CMS Releases Final CY 2015 ASC Payment Regulation: Slightly Improved Update


On October 31, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2015 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC).  The highlights for ophthalmic ASCs:

  • The 2015 rate proposal again contemplated an inflation update for ASCs based upon the Consumer Price Update –Urban (CPI-U), minus a “productivity adjustment” (MFP) mandated by the health care reform law. The final rule incorporates a 2015 ASC payment rate update of 1.4 percent – an increase of 0.2 percent over the proposed rule. 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.   The following are final 2015 rates for several high-volume ophthalmic procedures:


  • You will recall that last year CMS proposed that, effective in 2014, ASCs collect data and report on Measure ASC-11/NQF 1536, Improvement in Patient’s Visual Function Within 90 days Following Cataract Surgery. Based upon the lobbying efforts of the ASC and ophthalmology communities, 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.

We are disappointed, but not surprised, by CMS’ proposal in terms of the annual update.  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.  As we learned this past few months with the agency’s withdrawal of the misguided cataract quality measures, we can make a difference!

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: http://www.ofr.gov/OFRUpload/OFRData/2014-26146_PI.pdf.