Final 2017 Payment Rule: Higher Update And New Ophthalmic Quality Measure

On November 1, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2017 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers.  There are several issues that merit the attention of the ophthalmic ASC community.

ASC Payment Rates

In some good news, the final rule includes a 2017 update factor of 1.9 percent (based on a 2.2 percent CPI-U adjustment minus a 0.3 percent productivity adjustment).  This compares favorably to the 1.2 percent update included in the proposed rule.

Hospital outpatient departments will be afforded a 1.65 percent increase in 2017.

Quality Reporting

CMS has adopted a new ophthalmic quality measure, ASC 14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC.  Facilities will collect data in 2018 for the 2020 payment determination and subsequent years.  OOSS was instrumental in developing, testing, and advocating for this measure.

CMS also sought comment on a quality measure for future consideration addressing Toxic Anterior Segment Syndrome (TASS).  In our comments, OOSS supported adoption of the measure. CMS indicates that it will consider the measure for future inclusion in the program.

The agency also finalized measures that are collected utilizing the Outpatient and Ambulatory Surgical Center Consumer Assessment of Health Care Providers and Systems (OAS CAHPS) survey, including Facilities and Staff, Communication About Procedure, Preparation for Discharge and Recovery, Overall Rating of Facility, and Recommendation of Facility.  The surveys must be operational by 2018 and ASCs will be required to collect 300 completed surveys to meet reporting requirements.  OOSS will continue to lobby for reductions in the number and length of completed surveys.

Corneal Tissue

CMS will continue to limit payment for corneal tissue acquisition cost in the HOPD and ASC to tissue used only in corneal transplant procedures.


Should you have any questions regarding the final 2017 ASC payment rule, please contact OOSS Washington Counsel, Michael Romansky, at mromansky@localhost:8080/ooss