On July 29, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2020 payment rate regulation for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The proposed regulation will soon be published in the Federal Register. The Outpatient Ophthalmic Surgery Society (OOSS) and interested parties will have an opportunity to submit public comments until September 27, 2019. The rule and payment rates incorporate a number of policies for which OOSS has advocated for many years, according to an OOSS news release.
ASC Payment Rate Updates
As reported last year, CMS has agreed, for the period 2019-2023, to update ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban. OOSS has been a leader in the effort to effectuate this change for more than 20 years, seeking to persuade both CMS and Congress of its merits. Under this policy, ASCs would receive the same update as hospitals, subject to certain adjustments.
Under the ASC payment system, facilities receive a percentage of the relative weight assigned to a code for procedures furnished in HOPDs. The relative weights are re-calibrated each year based on a complex formula that takes into account a number of factors, including changes in hospitals costs in providing such services and the mandate that the ASC payment system remain budget-neutral.
Under the proposal, ASC payment rates would be updated by 2.7 percent in 2019 (reflecting the hospital market basket index of 3.2 percent less the MFP adjustment of 0.5 percent), according to the OOSS.
The following is a representative sampling of the proposed rate:
ASC Quality Reporting
CMS is proposing three modifications to the ASC Quality Reporting Program (ASCQR):
- Proposing one new quality measure for the ASCQR Program for the CY 2024 payment determination and subsequent years – ASC-19: Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers (NQF #3357). OOSS will object to the adoption of this measure as we believe that ASC measures should relate to episodes that occur during the surgical experience at the facility, are collectible by the ASC, and potentially generate actionable items for the facility.
- Proposing to change the submission method for ASC-1: Patient Burn, ASC-2: Patient Fall, ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant, and ASC-4: All-Cause Hospital Transfer/Admission measures to a CMS online data submission tool (i.e., QualityNet).
- Requesting comments on potentially adding to the Hospital QR Program in future rule-making, four patient safety measures previously adopted for the Ambulatory Surgery Center (ASC) Quality Reporting: ASC 1-4 (including ASC-1: Patient Fall, ASC-2: Patient Burn, ASC-3: Wrong Site, Wrong Side, Wrong Procedure, Wrong Implant, and ASC-4: All-Cause Hospital Transfers/Admissions).
Unlike the 2019 ASC payment rule, the agency is not proposing to remove any ASC quality measures.
For the past several years, OOSS and the ASC and ophthalmology communities have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency adopted in 2018 an ophthalmic quality measure, ASC 14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC. We will continue to recommend implementation of an ASC quality measure for TASS.
Payment for New Technology IOLs
ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS reports that there were no applications submitted by ophthalmic manufacturers requesting NTIOL status for lenses for the 2020 ASC payment rate rule-making.
The proposed regulation can be reviewed at: