CMS Releases Proposed CY 2017 ASC Payment Regulation: 1.2 Percent Update; Proposed Adoption of OOSS-Supported Quality Measure; And more

On July 6, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2017 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC).  The proposed regulation will soon be published in the Federal Register; OOSS and other interested parties will have an opportunity to submit public comments until September 6.

Below, please find a brief summary of key components of the proposed rule.

CY 2017 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 2017 proposal contemplates an inflation update for ASCs 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 2017 ASC positive payment rate of 1.2 percent. 

The following is a representative sampling of the proposed rates:

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 community will continue to vigorously lobby for the higher Hospital Market Basket update factor to be applied to ASCs.

ASC Quality Reporting

Since 2012, facilities have been subject to requirements (failure to report results in a 2 percent decrease in the annual update to ASC facility fees) to report on a number of quality measures, including: patient burns; patient fall in the ASC; wrong site, wrong side, wrong patient, wrong procedure, wrong implant; hospital transfer/admission; prophylactic IV antibiotic timing; procedure volume; use of a safe surgery checklist; and influenza vaccine coverage among healthcare workers.

For the past couple of years, OOSS and the ASC and ophthalmology communities have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures.

  • CMS has now proposed implementation of one such measure, ASC-14, Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC. Reporting would commence in 2018 with any impact on rates paid to facilities taking place in CY 2020.
  • The agency is soliciting comments regarding whether it should implement a quality measure addressing Toxic Anterior Segment Syndrome (TASS) in the future. The ASC Quality Collaboration (on whose Board of Directors OOSS sits) has developed such a measure.
  • CMS is also proposing that ASCs be required to administer and collect from ASC patients the Consumer Assessment of Healthcare Provider and Systems (CAHPS) survey. Facilities would be required to reach a 300-patient threshold each year. OOSS has expressed serious reservations about the practicability of administering this 37-question survey and will continue to present our concerns during the comment period.

New Technology Intraocular Lens (NTIOL) Payment

ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS reports that there were no applications submitted by ophthalmic manufacturers requesting NTIOL status for lenses for the 2017 ASC payment rate rulemaking.

Corneal Tissue

CMS is proposing to continue its policy, established last year, that separate payments to ASCs and HOPDs for corneal tissue acquisition costs will be limited to tissue used in the corneal transplant procedure and not for non-transplant procedures.

OOSS Action on this Rule

We are disappointed, but not surprised, by the proposed regulation, with respect to both the size of the update and the agency’s failure to adopt the Hospital Market Basket for ASCs. OOSS will submit comprehensive comments on these and other issues.

The proposed regulation can be reviewed at: CMS Proposed CY 2017 ASC Payment Regulation

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.

OOSS Symposium 2016@AAO/AAO New Chicago
Saturday, October 15, 2016, 9 am to 4 pm