The CMS proposed changes and policy updates to the Ambulatory Surgical Center Payment System and Outpatient Prospective Payment System, addressing the gap in payment rate between outpatient sites of service as well as encouraging non-opioid pain management at ASCs.
Here are 10 changes and updates to know:
1. The 2019 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule aims to address the differences in how CMS reimburses for HOPDs and ASCs. The proposed rule would align update factors for both sites of service, moving ASCs to the hospital market basket that updates HOPD payments.
2. CMS proposed to expand the number of procedures to the ASC covered procedures list that can safely be performed in an ASC setting, which includes certain cardiovascular surgical codes.
3. CMS is planning to review all procedures added within the last three years to reassess recent experience with the procedures in ASCs and determine whether they should continue to be on the ASC CPL. This is not out of the ordinary, and procedures that had previously been removed from the inpatient only list have been moved back in the past.
4. The proposed changes also include rules to ensure ASC payment for procedures involving certain high-cost devices matches the payment amount provided to hospital outpatient departments. CMS proposed to lower threshold for surgeries defined as device intensive from procedures where the device cost was 40 percent of the overall cost to 30 percent of the overall cost.
5. CMS proposed to pay separately for certain non-opioid pain management drugs in ASCs. Currently, Pacira's Exparel is the only non-opioid pain management therapy paid separately in ASCs, but the rule change could provide an opening for other opioid alternatives as well.
6. The proposal reduces the number of measures ASCs are required to report under certain "removal factors," including if they are duplicative, topped out or if the cost to report them is greater than the benefits of reporting.
7. The plan looks to reduce the cost of prescription drugs through a Competitive Acquisition Program model, which would allow CMS to introduce competition to Medicare Part B. A CAP-based model would encourage vendors to negotiate payment amounts for Part B drugs. CMS is also updating its 2018 policy allowing beneficiaries to save on drugs administered in hospital outpatient departments through the 340B program to include non-exempted off-campus departments under the physician fee schedule.
8. Under the proposed change, costs for clinic visits would lower from approximately $116 with a copayment of $23, to $46 with a $9 copayment, saving beneficiaries an average of $14 each time they visit an off-campus department. The changes are estimated to save Medicare $760 million in 2019.
9. CMS is accepting comments on the new changes until Sept. 24.
10. CMS plans to release the final rule at the end of 2018, to take effect in 2019.
Click here to view the full proposal.
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