On July 13, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2018 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 11, 2017. In summary:
• ASCs would, on average, receive a 1.9 percent inflation update in 2018 (compared with a 1.75 update provided to HOPDs).The facility fee for cataract surgery would be $1,000.
• CMS proposes to withdraw several existing quality measures and to adopt a measure, supported by OOSS, for TASS.
• CMS is delaying the requirement that ASCs participate in the burdensome Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS).
• The agency is soliciting comments on ways to improve delivery of care in the ASC, including easing the administrative burdens on facilities and physicians.
• CMS has not proposed further action regarding the establishment of a facility fee for office-based cataract surgery.


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 2018 proposal contemplates an inflation update for ASCs based upon the Consumer Price Update–Urban (CPI-U), which the agency estimates to be 2.3 percent. However, most health care providers will incur a “productivity adjustment” against their cost of living updates; CMS estimates that this adjustment will be 0.4 percent, which would result in a 2018 ASC positive payment rate of 1.9 percent. Please note that, for the first time, the payment rate for cataract surgery will be above $1,000.

The following is a representative sampling of the proposed rates:

OOSS_2018 Payment 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 (which are typically about a point higher), the agency has acknowledged that the CPI-U may not be the best inflator for ASCs. The agency states: “Currently, ASC payment rates are tied to data derived from the OPPS. Given concerns about the difference between OPPS payments relative to ASC payments (56 percent in 2017), CMS is soliciting comments on ways to improve payment accuracy to ASCs and seeking comments on the collection of ASC cost data.” OOSS will make a number of recommendations and will continue to vigorously lobby for the higher Hospital Market Basket update factor to be applied to ASCs.


For the past several years, OOSS and the ASC and ophthalmology communities have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency adopted last year 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.

For the 2021 payment period (and reporting in 2019), CMS has proposed adoption of a new measure, ASC-16: Toxic Anterior Segment Syndrome (TASS), which would be based on aggregate measure data collected by the ASC via chart abstraction and assesses the number of ophthalmic anterior segment surgery patients diagnosed with TASS within two days of surgery.

The agency is also proposing to remove three measures from the CY 2019 payment determination and thereafter: ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing; ASC-6: Safe Surgery Checklist Use; and, ASC-7: ASC Facility Volume Data on Selected Procedures.


In a very positive development, CMS is proposing to delay the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program for CY 2018 data collection. For years, OOSS has raised serious concerns with respect to the size and content of, and administrative and financial burdens associated with, the survey and joined the ASC community in lobbying for delay in requiring that facilities participate.


As noted above, ASC payment rates are linked to the APC relative values applied to hospital outpatient department rates. As such, some proposals within the rule, including those relating to packaging and bundling of services, may have an impact on 2018 ASC rates. We will provide you with a further update on these relevant changes.

OOSS and the ophthalmology and ASC communities have strenuously objected to the application of some packaging policies to ophthalmic surgical services performed in the ASC. We are pleased that CMS is soliciting comments on existing packaging policies under the HOPD payment system.


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 ophthalmics manufacturers requesting NTIOL status for lenses for the 2018 ASC payment rate rulemaking.


In the physician payment rule published on July 13, CMS is silent with respect to taking any further action regarding payment of a facility fee for office cataract surgery. This is great news – FOR NOW!! As you know, OOSS is the only ophthalmology organization to unequivocally oppose the implementation of payment for office cataract surgery. We are hopeful that CMS’ decision not to press forward with the establishment of payments for office cataract surgery is a final one. Should CMS further proceed in the near or distant term, the OOSS leadership assures you that this is our most important regulatory priority and we will be aggressive and zealous in safeguarding the interests of our patients and our centers.

The proposed regulation can be reviewed at: Proposed 2018 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.