CMS Proposed ASC Rule Issued Today: update of 2.8 percent, 5.5% for cataracts

CMS ISSUES PROPOSED 2024 ASC PAYMENT RULE: UPDATE of 2.8 PERCENT

On July 13, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2024 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 interested parties will have an opportunity to submit public comments until September 11, 2023. As discussed below, the rule and payment rates incorporate a number of policies for which OOSS has advocated for many years.

ASC Payment Rate Updates

CMS agreed, for the period 2019-2023, to update ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban. OOSS has been a leader in the effort to effectuate this change for over twenty years, seeking to persuade both CMS and Congress of its merits. Under this policy, ASCs have received the same update as hospitals, subject to certain adjustments. The policy was supposed to come up for review in this rulemaking. However, because of data problems associated with the pandemic, the agency is extending the application of the Hospital Market Basket to ASCs for an additional two years. In OOSS’ comments on the proposed rule, we will be recommending that CMS maintain permanently the application of the Hospital Market Basket in computing the annual ASC payment update.

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.

Under the new proposed policy, ASC payment rates would be updated by 2.8 percent in 2024 (reflecting the hospital market basket index of 3.0 percent less the MFP adjustment of 0.2 percent). The update percentage of 2.8 represents an average across all ASC procedures. Cataract surgery 66984 increased by 5.5 percent.

The following is a representative sampling of the proposed rates:

Proposed 2024 ASC Payment Rates for Ophthalmic Services

ASC Quality Reporting

CMS is proposing the following modifications to the ASC Quality Reporting Program (ASCQR):

The agency is not proposing to remove any ASC quality measures.

Regrettably and over the objections of the ASC and ophthalmology communities, CMS is proposing to finalize a misguided and administratively burdensome quality measure requiring facilities to report on patient visual function 90 days after cataract surgery. While all details are not yet available, facilities will be required to report utilizing the NEI VFQ-25; the Visual Functioning Patient Questionnaire (VF-14); or the Visual Functioning Index Patient Questionnaire (VF-8R). While CMS recommends that the physician’s office provide the data to the ASC, the ASC can administer the measure itself via phone, by the patient via regular or electronic mail, or during clinician follow-up. This measure remains voluntary through 2024.

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 in 2019 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. We will continue to recommend implementation of an ASC quality measure for TASS.

Payment for New Technology IOLs

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 2024 ASC payment rate rulemaking. As an incentive for innovation in monofocal IOL technology, OOSS and the IOL manufacturers are recommending that the $50 payment for NTIOL be increased to $92 to account for inflation.

The proposed regulation can be reviewed at: https://public-inspection.federalregister.gov/2023-14768.pdf.

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.

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