FASA Comments on CMS Proposed Changes to Medicare ASC Policy

ALEXANDRIA, Va. -- The Centers for Medicare and Medicaid Services (CMS) yesterday released a proposed rule recommending a new payment system for surgical procedures performed in ambulatory surgery centers (ASC). The Federated Ambulatory Surgery Association (FASA) comments on the most sweeping changes in Medicare ASC policy since the benefit was established in 1982. “FASA supports paying ASCs based on the hospital outpatient department (HOPD) payment system,” FASA president Kathy Bryant said. “We also applaud CMS for proposing to greatly expand the procedures ASCs are paid for performing.”

But Bryant cautioned that the proposed payment rate would result in many procedures not being viable in an ASC. “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 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 health care system by providing care at a lower cost with better patient satisfaction, this proposal would not advance the role ASCs play in Medicare.

Bryant added that, “Many ASCs, particularly single-specialty ones, will no longer be feasible at these rates.” CMS acknowledges that many of the procedures that would be cut under this proposal are procedures that thousands of Medicare beneficiaries are receiving today in ASCs. 

FASA says it is particularly concerned about Medicare beneficiaries accessing services in single-specialty ASCs that specialize in GI and pain management procedures.  These ASCs provide critical care to Medicare beneficiaries and pushing patients back into the hospitals would be a disservice to these beneficiaries, drive up the costs of program and limit physician choice on the most appropriate setting for each patient. 

Unfortunately, in the proposed rule CMS lost an opportunity to constrain overall Medicare spending on all outpatient surgery by failing to make lower cost ASCs an alternative and competitor to hospitals.  “We look forward to working with CMS during the next year to make sure that the final rule allows Medicare beneficiaries’ real choices for outpatient surgery.”

FASA says it believes the new payment system should be modeled on the Ambulatory Surgical Center Payment Modernization Act introduced by Sen. Mike Crapo (R-Idaho) and Rep. Wally Herger (R-Calif).  The proposed legislation recommends that ASCs receive 75 percent of the HOPD rate and make all payment policies more parallel between the two systems. 

FASA is analyzing the proposed rule and its methodology.  “Fortunately, the new payment system does not take effect until 2008, giving us time to work with CMS and Congress to make sure we get the new payment system right,” says Bryant.  “We look forward to providing CMS with hard numbers and policy rationale that demonstrate the need for a new payment system which will grant Medicare beneficiaries the same access to procedures in ASCs as other patients,” concluded Bryant.

Source: FASA