ASC Industry Continues Its Agenda as Nation Awaits Healthcare Reform Outcome

By all accounts, 2009 has been a significant year for healthcare-related activity on Capitol Hill. Providing the context for much of the politicking is healthcare reform legislation, which at the time of this writing, is still slogging its way clumsily through Congress. In November, the House of Representatives approved by a vote of 220 to 215 the $1 trillion Affordable Health Care for America Act; the Senate was still crafting a final bill for consideration on the floor.

Still unresolved is physician payment by the Centers for Medicare and Medicaid Services (CMS). A separate bill that aims to align payment rates more closely to the cost of providing care has been supported by the American Medical Association (AMA). In a statement issued in early November, AMA president J. James Rohack, MD, said, “As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled through passage of the Medicare Physician Payment Reform Act of 2009.”

As anticipated, in late October CMS announced that most hospitals will receive an inflation update of 2.1 percent in their payment rates for services furnished to Medicare beneficiaries in outpatient departments, and that ambulatory surgery centers (ASCs) will receive a 1.2 percent inflation update beginning Jan. 1, 2010. (CMS will reduce the update by 2.0 percentage points for hospitals that did not participate in quality data reporting for outpatient services or did not report the quality data successfully, resulting in a 0.1 percent update for those hospitals.) CMS projects that the aggregate Medicare payments to more than 4,000 hospitals in calendar year (CY) 2010 will be approximately $32.2 billion, while aggregate Medicare payments to approximately 5,000 ASCs will total $3.4 billion.

The payment updates are included in a final rule with comment period that revises payment policies and updates the payment rates for services furnished to beneficiaries during CY 2010 in hospital outpatient departments under the Outpatient Prospective Payment System (OPPS) and in ASCs under a revised rate-setting methodology that was implemented Jan. 1, 2008.