Halloween is still a few weeks away, and it’s still too soon to tell if the Centers for Medicare and Medicaid Services (CMS) gave us a trick or a treat when it delivered to the ambulatory surgery community – in the form of the proposed final rule -- a mixed bag of proposals, observations, and attempts to level the reimbursement playing field for ambulatory surgery centers (ASCs) and hospital outpatient departments. As you know, in early August CMS issued its proposed final rule that would establish a revamped ASC payment system to be implemented on Jan. 1, 2008. In 2007, CMS is aiming to add 14 procedures to the ASC list, and in 2008, CMS is proposing to expand the list of procedures for which ASCs may receive a facility fee by excluding from payment only those services that CMS believes pose a significant safety risk or require an overnight stay.
The ASC community is still digesting the ramifications of CMS’ proposed final rule. Craig Jeffries, executive director of the American Association of Ambulatory Surgery Centers (AAASC) explains that while the proposed ASC list expansion includes more than 750 procedures, most of these services are lower-intensity procedures typically performed in offices and for which payment rates are relatively low. He says, “Under this proposal, CMS is continuing to preclude ASCs from performing a multitude of higher intensity services that are clearly appropriate for the ASC setting.” Kathy Bryant, president of FASA, says she supports the concept of paying ASCs based on the hospital outpatient department (HOPD) payment system and appreciates this proposed expansion, but comments, “FASA is dismayed that CMS is proposing to pay ASCs 62 percent of what HOPDs get for providing the exact same surgical procedures. The proposed payment rate will result in Medicare beneficiaries and the Medicare program paying more for outpatient surgery because patients’ only choice for many surgical procedures will be the more costly hospital setting. The proposed payment rate is just not sufficient for ASCs to provide surgical procedures.”
FASA says the proposed reimbursement rate will put a financial damper on ASCs services, but the ultimate victims are beneficiaries across the nation who will lose access to the patient-centered care ASCs provide. Although CMS has publicly noted that ASCs play a very important role in creating a modern, innovative healthcare system by providing care at a lower cost with better patient satisfaction, this proposal would not advance the role ASCs play in Medicare. Bryant adds, “Many ASCs, particularly single-specialty ones, will no longer be feasible at these rates.” Jeffries notes further in a recent email alert, “In virtually every material respect, it is arbitrary, penurious, short-sighted, and unacceptable.”
No doubt the industry will have much more to say and do before the end of the year, and at this point, becoming as educated as possible on the issues is a must for all members of the ambulatory surgery community. Don’t miss Lorin Patterson’s take on this watershed event on page 10, and I encourage you to peruse the information we have posted on our Web site.
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