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ASCRS Recommends CMS Finalize Proposal to Update ASC Payments Using Hospital Market Basket in Comments on 2019 Proposed Rule; Urges CMS to Pay Separately for FDA-Approved Drugs Administered During or After Cataract Surgery That Have a Post-Operative Indic

This week, ASCRS joined with the Outpatient Ophthalmic Surgery Society (OOSS), the American Society of Retina Specialists (ASRS), and the Society for Eyecare Excellence (SEE) in comments on the 2019 ASC proposed rule. Our chief recommendation to CMS is that it finalize its proposal to update ASC payments using the Hospital Market Basket (HMB), rather than the current CPI-U index. We, and others in the ASC community, have long-recommended CMS make this change as it would more accurately account for the cost of providing care in the ASC setting. We agreed with CMS’ assessment that this change would drive more surgery to the lower cost ASC, but also recommended CMS eliminate the budget neutrality rescaler to achieve this goal.

Despite the positive proposal related to HMB, we expressed disappointment that CMS did not make any proposals related to separate payment for FDA-approved drugs administered during or immediately after cataract surgery that are not integral to the procedure but have an indication to treat or prevent postoperative concerns, such as pain and inflammation and in the future, infection. We are concerned that ASCs will not be able to afford to provide these drugs as part of the current facility fee if they are bundled. We first made this recommendation in our comments on the 2018 proposed rule in response to a request for information (RFI) from CMS. While CMS recognized the RFI in the previous year’s proposed rule, it did not address our recommendation related to drugs administered during cataract surgery in the 2019 proposed rule. However, it is proposing to pay separately beginning in 2019 for one non-opioid pain management drug, Exparel (bupivacaine liposome) in the ASC setting because the cost of the drug is too high for ASCs to cover with the facility fee. In our comments, we argue that ASCs face the same challenges affording all FDA-approved drugs with a post-operative indication, and therefore, they should also be paid separately.

Finally, we supported CMS’ proposal to remove ASC Quality Measure 11, Cataracts: 20/40 or Better Visual Acuity 90 Days Following Cataract Surgery because it is too onerous for ASCs to report, and currently only a voluntary measure. We asked CMS to consider finalizing a previous proposal to include a quality measure related to TASS, as it is relevant and reportable by the facility.

A final rule is expected in early November. We will keep you updated. 

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