FEATURE
rising cost of providing medical ser- vices. CMS has the authority to move ASCs from the CPI-U to the Hospi- tal Market Basket but has been hesi- tant to do so without congressional intervention. ASCA will continue to work with its champions in Congress to encourage the move. Advisory Panel on Hospital Out-
In the Pipeline
ASCA’s 2017 advocacy agenda BY KRISTIN MURPHY AND KARA NEWBURY
I
n 2017, ASCA will be working on many levels with multiple regula-
tory agencies and Congress to ensure that ASCs are at the table and in the conversation when federal policy decisions that affect surgery centers are made. Key areas ASCA will tar- get include: Medicare’s annual inflation- ary update: In 2003, Medicare paid ASCs 86 percent of the amount paid to hospital outpatient depart- ments (HOPD); today, Medicare pays ASCs 50 percent of the amount paid to HOPDs. This growing dis- parity
in reimbursement is caused
in part by the different inflationary update factors the Centers for Medi- care & Medicaid Services (CMS)
14 ASC FOCUS FEBRUARY 2017
Washington, DC, will continue to play a critical role in health care policy, and ASCA will continue to support policies nationwide that support ASCs in continuing to provide high-quality, cost-efficient care.
uses to update ASC and HOPD pay- ments each year. ASCs are updated based on the Consumer Price Index for All Urban Consumers (CPI-U), which measures the rising cost of goods like milk and eggs; HOPDs are updated based on the Hospital Market Basket, which measures the
patient Payment: ASCA will con- tinue to ask Congress to add an ASC voice to the Advisory Panel on Hos- pital Outpatient Payment (HOP). This panel, which seats up to 15 peo- ple, advises the secretary of the US Department of Health and Human Services (HHS) and the administra- tor of CMS on the clinical integrity of procedures within the hospital out- patient prospective payment system (OPPS), including “removing proce- dures from the inpatient list for pay- ment under the OPPS payment sys- tem.” ASC payment rates are tied to those in the OPPS. ASCA has already had some success with the HOP, as it unanimously recommended that CMS remove total knee arthroplasty (TKA) from its inpatient-only list, and hav- ing an ASC-specific panelist would provide more opportunities for future policy recommendations that are ben- eficial to ASCs. Adding procedures to the ASC-
payable list: Currently, CMS decides to keep a procedure off the ASC pro- cedure list based on the following exclusionary criteria: (1) generally results in extensive blood loss; (2) requires major or prolonged invasion of body cavities; (3) directly involves major blood vessels; (4) is gener- ally emergent or life-threatening in nature; and (5) commonly requires systemic
thrombolytic therapy. In
addition, if a code is on the inpatient- only list or is unlisted, it cannot be performed in the ASC setting. If CMS excludes a code based on one of the five exclusionary cri- teria above, it is not required to dis-
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