If finalized, the proposed CMS 2022 Hospital Outpatient Payment Prospective System and ASC Payment System rule may have lasting ramifications for ASCs and the healthcare system.
CMS proposed reversing several policies enacted during the Trump administration that took effect Jan. 1. The proposed rule would halt the gradual elimination of the inpatient-only list and remove hundreds of procedures added to the ASC-payable list this year.
Three observations:
1. The whiplash from drastic changes to CMS policy may have a chilling effect on whether ASCs add recently approved procedures in the future. Surgery centers anticipated the 2021 final rule paying for 266 new procedures would hold up at the beginning of 2021 and invested in equipment for additional service lines and volume.
"Some ASCs may make significant capital investments to begin performing newly added procedures, and to have those then removed a year later can impact their bottom line," Craig Gold, PsyD, administrator of Virginia Center for Eye Surgery in Virginia Beach, said. "Additionally, it may make ASCs reluctant to move forward with performing newly added procedures in the future."
2. Surgery for outpatient procedures will cost more. If Medicare removes surgeries from the ASC-payable list that have been proven effective in the outpatient setting, it will pay more for the surgery done in a hospital.
"ASC reimbursement is 32 percent less than hospital reimbursement, so the cost savings to the medical system and Medicare in particular would have been quite significant," said Dann Byck, MD, an orthopedic surgeon with Utah Orthopaedics in Ogden.
3. The lack of transparency in making coverage decisions is breeding distrust among ASC leaders. CMS does not share its process for making decisions about moving procedures from the inpatient-only to ASC-payable lists, and the vague reasons provided in the proposed rule have caused more than one administrator to raise an eyebrow.
"What is the research [CMS] considered in making this rule to begin with?" asked Lori Sylvester, administrator of Riverside Outpatient Surgery in Columbus, Ohio. "The communication stated that they didn’t consider all the research. Additionally, depending on a patient’s comorbidities, making an inpatient rule only increases the cost if the patient is a good candidate for outpatient settings. I believe surgeons and anesthesiologists should make the decision where the surgery should be performed based on established criteria."
Richard Rosenfield, MD, executive medical director and chief of gynecology at Pearl Women's Center and Pearl Surgicenter in Portland, Ore., is also skeptical of why the rules were changed. CMS stated in the 2022 proposed rule it received several comments critical of the 2021 final rule moving procedures away from the inpatient setting.
"This sounds like a terrible idea fueled by some backroom politics between hospital executives and the government," said Dr. Rosenfeld said. "Unless there is solid data to support this movement, it is a clear move by hospitals to protect revenue more so than ensure safety."