Complete Story


Changes Proposed on ASC Medicare Payments

Positive Corrections Possibly on the Horizon

Changes Proposed to ASC Medicare Payments

Yesterday, CMS released the 2019 proposed payment rule for ASCs and HOPDs. Of note, they have addressed a number of long-requested priorities for the ASC community, including proposing to align payment update factors, moving ASCs to the same factor used to update HOPD payments! This has been a long standing request of the national ASC Association (ASCA) and primary advocacy item during our Washington D.C. fly-ins over the past decade.

Under the proposal thanks to ASCA analysis, CMS would use the hospital market basket (same as HOPDs) to update ASC payments for the five-year period of calendar year 2019 through 2023.

As a result the proposed rule would increase ASC payments on average all covered procedures an effective 2.0 percent.

Additionally, there were a number of other important changes:

Device Intensive Procedures CMS is also proposing to define ASC device-intensive procedures as those procedures with a device offset percentage greater than 30 percent based on the standard OPPS APC rate-setting methodology. The current threshold is 40 percent, and lower proposed threshold would result in possible increased reimbursements for procedures with more expensive implant costs.

This will likely assist with Ohio BWC reimbursements, especially in the orthopedic setting since BWC has been utilizing that threshold for those reimbursements. OAASC will be working with Ohio BWC on their plans for incorporating this change into their joint replacement program.


Changes to List of ASC Covered Surgical Procedures CMS is proposing to add 12 cardiac catheterization procedures to the ASC covered procedures list. However, at this time they are not proposing the addition of any additional joint replacement procedures in an ASC for Medicare.

Changes to the ASC Quality Reporting Program CMS is proposing sweeping changes to the existing ASC Quality Reporting (ASCQR) Program. Most significantly, CMS is proposing to remove a total of 8 measures from the ASCQR Program measure set across the CY 2020 and CY 2021 payment determinations.

In 2020 they are proposing to remove:

  • ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel;

In 2021 they are proposing to remove:

  • Patient Burn;
  • Patient Fall;
  • Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant;
  • All-Cause Hospital Transfer/Admission;
  • Endoscopy/Polyp Surveillance Follow-up Interval for Normal Colonoscopy in Average Risk Patients;
  • Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use; and voluntary measure
  • Cataracts - Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery.

Additionally, CMS did not propose mandatory implementation of OAS CAHPS patient satisfaction survey in 2019.

Finally this week, the U.S. of Representatives passed the Ambulatory Surgical Center (ASC) Payment Transparency Act of 2018. This legislation would require CMS to disclose why certain outpatient surgical procedures that can safely be performed in an ASC are excluded on the ASC procedure list. It would also require an ASC representation on the panel that advises CMS on payment policies for both HOPDs and ASCs.


ALL of these accomplishments are because of all the efforts that ASC leaders have put into advocacy through your visits, phone calls, letters and emails to our national representatives in Washington, D.C.


More still needs to be done on these and other issues and your advocacy will be needed.


To get the FULL details on all of these changes and possible changes to the survey guidance for Medicare surveyors, make sure you attend our conference in September and attend the sessions on regulatory changes and life safety code updates!

2018 Annual Conference - Celebrating 20 Years of the OAASC

Details and analysis courtesy of ASCA

Printer-Friendly Version