CMS issued the 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule Nov. 1, with slight pay bumps in each setting despite continued inflation and specialist shortages.
"This final rule is a step sideways in a time when millions of Medicare beneficiaries need CMS to advance policies that expand access to the safe, convenient and efficient care that surgery centers provide," said ASCA CEO Bill Prentice in a news release. "CMS must recognize the enormous impact of rising employment and anesthesia costs, and reform outdated budget policies that shortchange ASC reimbursements so that surgery centers can better serve Medicare patients in their communities."
Four things for ASCs to know:
1. CMS finalized a reimbursement increase of 2.9% for ASCs meeting quality reporting requirements next year. The update is based on a projected hospital market basket percentage increase of 3.4%, and then a 0.5 percentage point productivity adjustment. The final rule is 0.3% up from the proposed rule.
2. Next year, CMS made a few updates to the ASC quality reporting program:
Facility commitment to health equity measure for the 2025 reporting period
Social drivers of health measure screening for voluntary reporting next year
Screen positive rate for social drivers of health for voluntary reporting next year
3. CMS also added case minimums for specialty measure reporting and removed specialty measures with zero cases from attestation requirements for surgery centers. Going forward, CMS will also verify case counts using claims data to determine specialty measures for individual ASC reporting.
4. CMS did not add any surgical procedures to the ASC covered list for next year. The agency did add 19 dental codes and two adipose-derived regenerative cell therapy codes.
"ASCA strongly supports health equity and access to care for all patients. However, this rulemaking does not make clear how the measures will address the disparities that exist or how CMS will support the facilities required to collect this information," said Mr. Prentice. "If these measures had been tested in the ASC setting before being proposed, let alone adopted, the Agency would have realized that the ASC setting is not the proper site of service to obtain this data."