FASA, AAASC Provide CMS with Suggestions for an Improved ASC Payment System
FASA and AAASC have both issued significant recommendations to the Centers for Medicare and Medicaid Services (CMS) outlining improvements that should be made to a proposal for a new payment system for surgical procedures performed in ambulatory surgery centers (ASCs). FASA’s recommendations, if adopted by CMS, would preserve and expand surgical services available to Medicare beneficiaries as part of the most sweeping changes in Medicare ASC policy since the benefit was established in 1982.
In a letter to Leslie V. Norwalk, Esq., acting administrator of CMS, John Duggan, MD, president of the American Association of Ambulatory Surgery Centers (AAASC) writes, “The broad statutory authority granted to the Secretary to design a new ASC payment system in the Medicare Modernization Act of 2003 (MMA) presents CMS with a unique opportunity to significantly improve Medicare beneficiaries’ access to ASC services. The ASC community welcomes the opportunity to link the ASC and hospital outpatient department (HOPD) payment systems. Although the HOPD payment system is imperfect, it represents the best proxy for the relative cost of procedures performed in the ASC. By linking the ASC and HOPD payment systems, the Medicare program can achieve significant benefits. However, there are several provisions of this proposed rule that might reduce, rather than expand, access to surgical care because the proposal’s links to the HOPD system are selective and incomplete. To achieve the best access to surgical services for Medicare beneficiaries, CMS should focus on three basic principles as it implements a new payment system:
ensuring meaningful beneficiary access to the wide range of surgical procedures that can be safely and efficiently performed in the ASC; establishing fair and reasonable payment rates to allow beneficiaries and the Medicare program to save money on procedures that can be safely performed at a lower cost in the ASC, rather than in the HOPD; and making the ASC and HOPD payment systems consistent to the maximum extent possible to provide Medicare beneficiaries with greater price transparency and eliminate distortions between the payment systems that could inappropriately influence site of service selection.”
As recently as 2003, there was only an 86 percent difference in the ASC and hospital outpatient department payment (HOPD) rates. FASA concedes that Congress did limit the Administration’s flexibility by imposing a budget neutral system. In its comments FASA provides details as to how the budget neutrality requirement can be met if ASCs are paid 73 percent of the rate for hospital outpatient surgery.
According to Bryant, “This ASC payment system reform provides CMS the chance to significantly improve Medicare beneficiaries’ access to ASC services. We urge CMS to adopt our recommendations, thus promoting quality and achieving cost savings for the program and for beneficiaries.”
FASA supports legislation introduced by Senator Mike Crapo (R-ID) and Representative Wally Herger (R-CA), the Ambulatory Surgical Center Medicare Payment Modernization Act (S. 1884/H.R. 4042) as the best way of reforming the ASC payment system. This legislation would pay ASCs 75 percent of the hospital rate, apply the same policies as in hospital outpatient departments, and provide appropriate transition rules so that Medicare beneficiaries’ access would be protected.