Medicare's 2017 Final Rule Released

The Centers for Medicare & Medicaid Services (CMS) released its final 2017 ASC payment rule today. ASC payment rates will increase by 1.9 percent in 2017. This increase is based on a projected rate of inflation of 2.2 percent minus a 0.3 percentage point productivity adjustment required by the Affordable Care Act. This increase is larger than the 1.2 effective updated that was included in the proposed rule.

Hospital outpatient departments (HOPDs) will receive a 1.65 percent increase, based on a 2.7 percent market basket minus a 0.3 percent adjustment for economy-wide productivity a 0.75 percentage point adjustment required by statute.

However, CMS does not consider sequestration in this rule. This statutory 2 percent reduction remains in effect until at least 2024 unless Congress acts.

Ten new procedures finalized; all packaged

The agency did finalize the addition of ten new procedures to the ASC list of payable procedures for 2017. Unfortunately, these codes are add-on codes, and thus will not be separately payable when performed in the ASC. These codes are:

CMS did finalize the addition of the following seventeen codes to the ASC-payable list:

  • 20936 (Sp bone agrft local add-on)

  • 20937 (Sp bone agrft morsel add-on)

  • 20938 (Sp bone agrft struct add-on)

  • 22552 (Addl neck spine fusion)

  • 22840 (Insert spine fixation device)

  • 22842 (Insert spine fixation device)

  • 22851 (Apply spine prosth device)

  • 22853 (Insertion of interbody biomechanical device(s))

  • 22854 (Insertion of intervertebral biomechanical device(s))

  • 22859 (Insertion of intervertebral biomechanical device(s))

ASCA advocated for dozens of other codes to be added to the list of ASC-payable codes. In this rule, CMS indicated that it was not adding any of the requested codes because they do not meet their criteria for inclusion on the list. However, CMS did not explain which of the criteria the codes did not meet. “ASCA is disappointed that CMS refuses to acknowledge that many more procedures are being performed safely and effectively in the ASC setting on non-Medicare patients every day,” stated Bill Prentice. “Allowing ASCs to perform more outpatient procedures would increase access to care for those served by the Medicare program while also saving the system billions of dollars over time.”

Solicitation of Public Comments on the Possible Removal of Total Knee Arthroplasty (TKA) Procedure from the IPO List

CMS sought public comments on whether CPT code 27447 (Total knee arthroplasty) should be removed from the inpatient-only list. While no official action was taken, as this was simply a solitication for comments and not a formal proposal, CMS acknowledged that the vast majority of the comments were supportive of this move. CMS indicated it will take these comments into consideration during future rulemaking. ASCA has been advocating for this code’s removal from the inpatient-only list, and will continue to do so.

Changes to the ASC Quality Reporting Program, including adoption of OAS CAHPS

CMS finalized seven new measures to be added for 2020 payment determinations.

Two measures require data to be submitted directly to CMS via a CMS Web-based tool: (1) ASC-13: Normothermia Outcome, percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU), and (2) ASC-14: Unplanned Anterior Vitrectomy, a procedure performed when vitreous inadvertently prolapses into the anterior segment of the eye during cataract surgery.

Five measures are based on the use of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS). They are: (1) ASC-15a: OAS CAHPS – About Facilities and Staff; (2) ASC- 15b: OAS CAHPS – Communication About Procedure; (3) ASC-15c: OAS CAHPS – Preparation for Discharge and Recovery; (4) ASC-15d: OAS CAHPS – Overall Rating of Facility; and (5) ASC-15e: OAS CAHPS – Recommendation of Facility.

Facilities will need 300 completed surveys from patients to meet the reporting requirements. This survey will need to be operational in facilities by 2018. In 2017, ASCA will continue to advocate for reductions in the length and number of completed surveys required in the 2018 payment rule that will be finalized prior to the full implementation of the OAS CAHPS survey.

Click here to download the final rule. ASCA will conduct a more comprehensive review of the rule in and provide more information in the coming weeks to help ASC operators understand the impact of the final rule on their facilities.

For more information, contact Kara Newbury at knewbury@ascassociation.org.