or of moving total knee or other joint replacements to the ASC-payable list.

Device-Intensive Threshold Change CMS proposed to drop the device- intensive threshold from 40 percent to 30 percent. This means that if the device portion of the overall procedure cost when done in the HOPD setting is equal to or greater than 30 percent, that device cost would be contemplated in the ASC payment rate. This is another change that ASCA requested for years and strongly supported in its formal comments to CMS.

Payment for Non-Opioid Pain Management Drugs CMS proposed to provide separate payment for non-opioid pain man- agement drugs that function as a sup- ply when used in a surgical procedure when the procedure is performed in an ASC. Currently, HCPCS code C9290, Exparel, is the only code that meets the proposed criteria and will receive separate payment when used in a sur- gical procedure when the procedure is performed in an ASC. ASCA supports policies that encourage the use of non- opioid pain management products.

ASC Quality Reporting Program Changes

CMS proposed sweeping changes to the ASC Quality Reporting (ASCQR) Program. Most significantly, it pro- posed to remove a total of eight mea- sures from the ASCQR Program mea- sure set across the CY 2020 and CY 2021 payment determinations. Specifically, beginning with the CY 2020 payment determination, CMS proposed to remove ASC-8: Influenza Vaccination Coverage Among Health- care Personnel. Beginning with the CY 2021 pay-

ment determination, it is proposing to remove: ASC-1: Patient Burn; ASC- 2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; ASC-4:

For the first time since the ASC and HOPD payment systems were aligned in 2009, CMS proposed to use the same update factor for our setting as it uses for hospitals.”

—Kara Newbury, ASCA

All-Cause Hospital Transfer/Admis- sion; ASC-9: Endoscopy/Polyp Sur- veillance Follow-up Interval for Nor- mal Colonoscopy in Average Risk Patients; ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adeno- matous Polyps—Avoidance of Inap- propriate Use; and voluntary measure ASC-11: Cataracts—Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery. If these changes are adopted in the

final rule, ASCs can stop collecting data for ASC-8 immediately and stop reporting on Medicare claims ASC-1 through ASC-4 beginning January 1, 2019. To qualify for their full pay- ment update in 2020, however, facili- ties still need to report the data they collect this year on measures ASC-9 and 10 in 2019. Reporting on ASC- 11 already is voluntary, so there are no additional reporting requirements tied to that measure.

30 ASC FOCUS OCTOBER 2018 | Beginning in 2019, ASCs will also

need to report information they began collecting this year on two new mea- sures—ASC13: Normothermia and ASC-14: Unplanned Anterior Vitrec- tomy. These reporting requirements were not changed in the proposed rule. Two new measures finalized in 2018 rulemaking will begin for CY 2022 payment determinations: ASC-17: Hos- pital visits after orthopedic ASC proce- dures and ASC-18: Hospital visits after urology ASC procedures.

CMS did not propose to man- date implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambula- tory Surgery Survey (OAS CAHPS) under the ASCQR Program at this time, and there was no mention of the Ambulatory Breast Procedure Surgi- cal Site Infection Outcome measure, which was mentioned in the 2018 rule.

Requests for Information In addition to the formal proposals con- tained in the rule, CMS has requested input on various topics. In its com- ments, ASCA addressed the following requests for information (RFI): ■■

Request for Information on Promot- ing Interoperability and Electronic Healthcare Information Exchange through Possible Revisions to the CMS Patient Health and Safety Requirements for Hospitals and Other Medicare and Medicaid Par- ticipating Providers and Suppliers


Request for Information on Price Transparency: Improving Benefi- ciary Access to Provider and Sup- plier Charge Information

CMS will respond to comments in a final rule scheduled to be released on or around November 1, 2018. ASCA will alert its members to the final rule’s release the day it comes out. Please make sure that you are receiving emails from ASCA.

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

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