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