The Ambulatory Surgery Center Association supports the newly-introduced Ambulatory Surgical Center Quality and Access Act of 2015.
Senator Michael Crapo (R-ID) introduced the bill in the U.S. Senate along with cosponsors, including Lamar Alexander (R-TN), Richard Blumenthal (D-CT) and Chris Murphy (D-CT). U.S. Representative Devin Nunes (R-CA) introduced the comparable legislation in the House back in March. The bill now has 43 cosponsors.
Here are five key notes:
1. The legislation fixes flaws in the current law allowing CMS to use different measures of inflation for ASCs and hospital outpatient departments when setting rates. The current measures penalize ASCs.
2. The bill is designed to help prevent ASC procedures from migrating to the HOPD setting, which is more expensive. ASCs are the low cost setting and the legislation is meant to encourage savings for Medicare beneficiaries who receive care at ASCs.
3. The legislation requires CMS to publish relevant quality data so patients can compare quality across sites of service.
4. CMS would be required to add an ASC representative to its Advisory Panel on Hospital Outpatient Payment if the legislation is passed. The panel makes decisions that affect both HOPD and ASC facility fees and eligible procedures.
5. When procedures are left off the ASC approved list, the legislation would require CMS to disclose which of the triggers excludes the procedures from the approved list.
"The current reimbursement structure irrationally uses a flawed inflation factor to update ASC payments under Medicare, resulting in an ever-increasing disparity in reimbursement between ASCs and hospital outpatient departments when providing identical care," said ASCA CEO William Prentice. "Without a fix, the disparity between ASC and HOPD payments will continue to widen, challenging the ability of some ASCs to survive. Even CMS actuaries have acknowledged that the use of the consumer price index for all urban consumers is unfair."