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REGULATORY REVIEW


issue and can help communicate to CMS their support for this change.


Support CMS’ continued use of the hospital market basket as the annual update mechanism for ASC payments. When CMS implemented the revised ASC payment system in 2008, the agency’s stated goal was to encour- age high-quality, efficient care in the most appropriate


outpatient


setting


and, in many cases, be cut to main- tain budget neutrality within the ASC payment system year after year. This is clearly untenable with more surgi- cal volume being driven to the out- patient setting in general and CMS’ stated desire for procedures to move to the lower-cost ASC setting. Too much surgical care that could be safely per- formed in ASCs continues to be pro- vided


predominantly in hospitals,


which we largely attribute to Medi- care’s failure to pay reasonable rates to ASCs. This lack of migration comes at a high price to the Medicare program, the taxpayers who fund it and the ben- eficiaries who needlessly incur higher out-of-pocket expenses. According to the Social Security


Act § 1833, under the statute implement- ing the new ASC payment system in 2008, CMS was required to apply this budget neutrality adjustment only in the first year of implementation of the new payment system. Accordingly, the agency is needlessly increasing Medi- care program costs by making it finan-


30 ASC FOCUS MAY 2021 | ascfocus.org


2022 Outlook: We do not anticipate this policy change in 2022. We are working on the long game, however, which is why we spent time during our spring meeting with payment policy staff to make sure they knew this would be a priority moving forward. We also are planning on adding an ASC weight scalar fix to our association-driven leg- islation this session. This strategy pro- vides legislative language we can try to get inserted in other larger bills that are moving through Congress regardless of whether the bill moves as stand-alone legislation. It also ensures that our sup- porters on Capitol Hill understand the


cially untenable for ASCs to perform many procedures that are otherwise clinically appropriate and encourag- ing physicians and hospitals to furnish those procedures in the more expen- sive HOPD setting. To ensure that ASCs remain a viable alternative for Medicare beneficiaries in need of out- patient surgical care, CMS must dis- continue use of the ASC weight scalar.


and align payment policies to elimi- nate payment incentives favoring one care setting over another, according to the CY 2007 OPPS/ASC proposed rule. Since 2008, the ASC commu- nity has urged CMS to adopt the same update factor for both ASC and HOPD payments. In the 2019 final payment rule, CMS announced a plan to align the ASC update factor with the one used to update HOPD payments—the hospital market basket—for CY 2019 through CY 2023. According to CMS, this trial period will give the agency time to assess this policy’s impact on volume migration.


2022 Outlook: ASCA staff are cau- tiously optimistic that CMS staff will continue with the five-year pilot, even though there are concerns the new administration could reverse this pol- icy. Due to data lag, information on the ASC volume from the first year of the five-year pilot, 2019, has just recently become publicly available, so there is limited information available to CMS staff as to the impact of the policy thus far. By keeping the pilot in place, CMS staff will have the opportunity to work with the new political appointees and evaluate at least two years of volume data to determine whether this policy change has positively impacted a shift in migration to the lower-cost ASC set- ting. ASCA also will continue to pur- sue a more permanent fix through leg- islation, especially since we believe the ASC weight scalar is such a disin- centive for shifting volume that CMS


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