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REGULATORY REVIEW


the scaling factor for ASCs will rarely result in an increase in ASC relative weights. In fact, since the current ASC payment system was implemented, the rescaling adjustment has decreased the relative weights on ASC surgical pro- cedures each year. More specifically, as the graph on the right shows, since 2010, the rescaling has decreased the relative weights in the ASC system by, on average, 7.0 percent each year. In the last seven years, the size of


the rescaling has increased nearly every year. The rescaling was 0.9332 in cal- endar year (CY) 2016, proposed to be 0.9030 in CY 2017, and finalized at 0.9000 for 2017. The change between the proposed rule and final rule in the rescaling helps explain why many ASCs saw their payment rates drop even though the conversion factor increased between the proposed and final rules.


0.98 0.97 0.96 0.95 0.94 0.93 0.92 0.91 0.90


ASC Rescaler [2010–2017 (Proposed)]


CY 2010 CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY 2017 Source: ASCA


This historical trend, and the absence of any indication that it is likely to reverse in the future, suggests that the applica- tion of the rescaling in the ASC setting will continue to erode the relationship between ASC and HOPD rates. By applying ASC-specific adjust-


ments like the scaling, CMS is acceler- ating and exacerbating the gap between


OPPS and ASC rates. In so doing, the agency is, at worst, costing the program money by making the ASC a financially untenable setting for many procedures that are otherwise clinically appropri- ate for the ASC and encouraging phy- sicians and hospitals to furnish those procedures in the more expensive— and in many cases, now doubly expen-


28 ASC FOCUS JUNE/JULY 2017 |www.ascfocus.org


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