sive—HOPD setting, or at least depriv- ing the program and its beneficiaries of substantial cost savings. For this reason, ASCA has been advocating for CMS to make changes to ASC payment policy that would arrest this growing gulf in payment amounts. Specifically, we urge CMS to discontinue use of the ASC rel- ative weight scaling, which contributes substantially to the rate divergence. ASCA believes that CMS must take steps to ensure that any budget neutral- ity calculations performed while setting ASC rates do not inadvertently discour- age ASCs from performing procedures in the ASC setting. Specifically, if CMS chooses to retain the rescaling, the agency should create a minimum ratio of ASC payment to OPPS payment for any service whose payment rate is based on OPPS payments (i.e., exclud- ing those that are based on physician fee schedule payment amounts). CMS

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should implement this relative floor in such a way that no service in an ASC is paid less than 55 percent of the compa- rable OPPS payment rate. This was the typical payment ratio

between these sites of care in CY 2014 before the creation of the Comprehen- sive APCs (C-APCs) began to cause

further divergence between the payment rates in the ASC and HOPD settings. C-APCs are more inclusive bundled outpatient codes similar to inpatient diagnosis-related groups that CMS finalized in recent years for HOPD pay- ments but not ASC payments. Since ASC payments are based on HOPD cost reports, there are concerns that codes that are still separately payable in the ASC setting but now packaged in the HOPD setting are not being accu- rately captured on HOPD cost reports. We recommend that for OPPS codes

that fall into Comprehensive APCs, this floor should be implemented rel- ative to the alternative payment rate (i.e., without C-APC status) for these codes, which CMS already calculates in the process of setting ASC rates.

Kara Newbury is ASCA’s regulatory counsel. Write her at


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