07/07/2014

2015 Medicare Proposed Payment Rule Released

ASCs receive 1.2% rate increase / 10 new spine procedures approved

The Centers for Medicare & Medicaid Services (CMS) released the 2014 proposed payment rule for ASCs and hospital outpatient departments (HOPDs) last Thursday. Click here to download a copy of the 687 – page proposed rule.

CMS has proposed raising Medicare outpatient payments to hospitals by 2.1% in 2015, while ambulatory surgery centers would receive a 1.2% increase. The 2.1% update for hospitals was calculated from a 2.7% market-basket increase, minus a 0.4% productivity adjustment and a 0.2% cut required by the Patient Protection and Affordable Care Act. The rate increase for surgery centers reflected a 1.7% update to the consumer price index, offset by a 0.5% productivity adjustment.

It is disappointing that the agency continues to use the consumer price index for All Urban Consumers (CPI-U) to update ASCs rates. The CPI-U has been widely criticized as an inappropriate measure of inflation in the cost of providing health care. The hospital market basket is a more appropriate cost measure. The end result is that under the proposal, the rates paid to ASCs and HOPDs will continue to grow farther apart.

A positive outcome is ten new spine procedures are proposed to be added to the ASC approved list of procedures for 2015. CASA Board member, Tom Wilson, Orthopedic Surgeon Sohrab Gollogly MD of Monterey CA, and staff from the Ambulatory Surgery Center Association (ASCA), conducted a presentation for CMS staff earlier this year that highlighted the safety and efficacy of these procedures when performed in the ASC setting.

The proposed new codes are the following:

• 22551  Neck spine fuse&remov bel c2
• 22554  Neck spine fusion
• 22612  Lumbar spine fusion
• 22614  Spine fusion extra segment
• 63020  Neck spine disk surgery
• 63030  Low back disk surgery
• 63042  Laminotomy single lumbar
• 63045  Removal of spinal lamina
• 63047  Removal of spinal lamina
• 63056  Decompress spinal cord

The proposal also includes changes to the Device-Intensive policy as well as updates to the mandated quality measures:

• Significant Change to Device-Intensive Policy: CMS is proposing to define ASC device-intensive procedures as those procedures that are assigned to any APC (not only an APC formerly designated device-dependent) with a device offset percentage greater than 40 percent based on the standard OPPS APC rate setting methodology.
• CMS Proposes to Make ASC-11 a voluntary measure. Citing operational difficulties with the measure, CMS has proposed to make ASC-11: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery, a voluntary measure in the ASC Quality Reporting Program.
• One new quality measure added. CMS is proposing the addition of one new measure, ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy, which will affect payment in CY 2017, with data collection beginning in CY 2015.

CASA will continue to work with industry experts and ASCA to further analyze the rule and provide you with potential impacts the rule may cause to your centers operations.