CMS Releases Proposed Rule for 2018 ASC Payment
2018 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM PROPOSED RULE RELEASED
2018 ASC Conversion Factor Projected at $45.876 for Those Meeting Quality Reporting Requirements
The Centers for Medicare & Medicaid Services (CMS) has issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule. The rule has a 60 - day comment period, and ASCRS will be providing comments.
ASC Conversion Factor
For CY 2018, CMS proposes to adjust the CY 2017 ASC conversion factor ($45.003) by the wage adjustment budget neutrality factor of 1.0004 in addition to the MFP-adjusted CPI-U update factor of 1.9%, which results in a proposed CY 2018 ASC conversion factor of $45.876 for ASCs meeting the quality reporting requirements.
For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2017 ASC conversion factor ($45.003) by the wage adjustment for budget neutrality factor of 1.0004 in addition to the quality reporting/MFP-adjusted CPI-U update factor of -0.1%, which results in a proposed CY 2018 ASC conversion factor of $44.976 for ASCs not meeting the quality reporting requirements.
ASC Quality Reporting Program (ASCQR)
CMS is proposing to add three measures to the ASCQR measure set for 2021 and 2022 payment determination and subsequent years.
The three proposed measures are:
- ASC-16: Toxic Anterior Segment Syndrome (TASS) measure, which is based on aggregate measure data collected by the ASC via chart abstraction and assesses the number of ophthalmic anterior segment surgery patients diagnosed with TASS within two days of surgery (beginning with the CY 2021 payment determination).
- ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures, which assesses all-cause, unplanned hospital visits within seven days of an orthopedic procedure performed at an ASC (beginning with the CY 2022 payment determination). For the purposes of this measure, “hospital visits” include emergency department visits, observation stays, and unplanned inpatient admissions.
- ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures, which assesses all-cause, unplanned hospital visits occurring within seven days of the urology procedure performed at an ASC (beginning with the CY 2022 payment determination). For the purpose of this measure, “hospital visits” include emergency department visits, observation stays, and unplanned inpatient admissions.
CMS is also requesting comment on its proposals to remove three measures for the CY 2019 payment determination and subsequent years. The three measures are:
- ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing, which assesses whether intravenous antibiotics given for prevention of surgical site infection were administered on time.
- ASC-6: Safe Surgery Checklist Use, which is a structural measure of facility process that assesses whether an ASC employed a safe surgery checklist that covered each of the three critical perioperative periods (prior to administering anesthesia, prior to skin incision, and prior to patient leaving the operating room) for the entire data collection period.
- ASC-7: ASC Facility Volume Data on Selected Procedures, which is a structural measure of facility capacity that collects surgical procedure volume data on six categories of procedures frequently performed in the ASC setting.
For the CY 2020 payment determination (CY 2018 data collection) and subsequent years, CMS is proposing to delay the mandatory implementation of the Consumer Assessment of Health Care Providers and Systems Outpatient and ASC Survey for CY 2018 Data Collection.
Request for Information on Regulatory Relief
CMS is releasing a Request for Information regarding positive solutions to better achieve transparency, flexibility, program simplification and innovation related to outpatient services performed at hospitals and services performed at ASCs. They specifically focus on making the system less bureaucratic and complex; less burdensome for clinicians and providers, while improving quality of care and reducing costs.
Soliciting Comments on Packaging Policies
CMS is soliciting comments on existing packaging policies under the OPPS, including those related to drugs that function as a supply in a diagnostic test, diagnostic procedure, or surgical procedure. They are also interested in feedback on common clinical scenarios involving separately payable items and services for which payment would be most appropriately packaged.
Additional information will be detailed in upcoming editions of Washington Watch Weekly. For questions, please contact Allison Madson, manager of regulatory affairs, at 703-591-2220 or firstname.lastname@example.org