COVER STORY


ASC Advocacy Posts Gains


Groundwork laid for future success BY JEFF EVANS AND ALI LEGROS MURPHY


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ast year was an important year for the ASC community, as ASCA and its members achieved several ben- eficial policy changes through stead- fast federal and state advocacy efforts. ASCA is optimistic about 2018 and, with its members, continues to work with Congress, regulatory agencies and state legislatures across the coun- try to ensure ASCs are represented as policy decisions are made.


On Federal Level Each year, the Centers for Medicare & Medicaid Services (CMS) updates the Hospital Outpatient Prospective Pay- ment System (OPPS) and Ambulatory Surgical Center Payment Systems. Last year, as part of that update, CMS finalized three provisions that posi- tively impact ASCs: New Procedures: CMS added three new CPT codes to the ASC list of


covered surgical procedures for 2018, which means that ASCs will now be reimbursed for performing these pro- cedures on Medicare beneficiaries for the first time: ■■


22856 (Cerv artific diskectomy); ■■ ■■


22858 (Second level cer diskec- tomy); and


58572 (Tlh uterus over 250 g). Total Knee Arthroplasty: CMS


removed total knee arthroplasty (TKA) from its inpatient-only (IPO) list. TKA can now be performed in the outpa- tient setting for Medicare beneficiaries and is one step closer to being added to the ASC list of covered surgical pro- cedures. ASCs are already performing TKA and other joint replacement pro- cedures on privately insured patients. OAS CAHPS Delay: CMS pre- viously stated it would mandate ASC use of the Consumer Assessment of Healthcare Providers and Systems


10 ASC FOCUS MARCH 2018 | www.ascfocus.org


Outpatient and Ambulatory Surgery Survey (OAS CAHPS) beginning in 2018. Intended to measure patient experience in ASCs and hospital out- patient departments (HOPD), OAS CAHPS in its current form has proved more burden than benefit. CMS recog- nized ASCA comments and delayed implementation of OAS CAHPS until further action in future rulemaking. Work remains in 2018 to champion policies that will help ASCs continue to provide high-quality, cost-effective services. Key ASCA advocacy priori- ties include: Medicare inflationary update to ASC payment: In 2003, Medicare paid ASCs 86 percent of the amount paid to HOPDs; today, the ASC Medi- care payment rate has dropped to 49 percent of HOPD payments. This growing disparity in reimbursement is caused in part by the different infla- tionary update factors CMS uses to update ASC and HOPD payments each year. ASCs are updated based on the Consumer Price Index for All


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