Here's a timeline of CMS news from 2018 with implications for ASCs:
Feb. 22, 2018
Orthopedic society criticizes CMS for TKA final rule.The American Association of Hip and Knee Surgeons issued a statement on the 2018 Medicare Outpatient Prospective Payment System rule that removed total knee arthroplasty from Medicare's inpatient-only list.
May 2, 2018
CMS unveils surveyor training website with ASC courses.The CMS survey and certification group launched a training website to help surveyors and facilities prepare for upcoming surveys.
June 21, 2018
Stark Law under the spotlight as CMS seeks to ease self-referral regulatory burden. CMS began seeking input on reducing the regulatory burden of Stark Law to allow for more care coordination between organizations. The June 2018 MedPAC report also addressed potential Stark Law changes, focused on tightening the language to prohibit physician self-referral associated with physician-owned distributorships.
July 26, 2018
CMS proposes 2 percent ASC pay increase in 2019.In a 761-page proposal, CMS released the 2019 proposed payment rule for ASCs and hospital outpatient departments, addressing payment factors and potential changes in the quality reporting system. The proposed rule would increase payment to ASCs on all covered procedures by 2 percent on average.
July 26, 2018
CMS considers removing eight ASC quality reporting measures.Within its proposed 2019 ASC and HOPD payment update, CMS addressed the ASC Quality Reporting Program. The proposed updates would remove eight measures from the required reporting list for payment determination over the next few years.
July 30, 2018
CMS reviews same-day spine cases for beneficiaries.CMS proposed reviewing whether 38 procedures added to the ASC list of allowable procedures should remain on that list. Twenty-five of those procedures involved spine surgery.
Aug. 23, 2018
CMS considers adding 12 cardiac catheterization procedures to ASC covered list. CMS proposed changing the definition of surgery to account for "surgery-like" procedures in the 2019 proposed payment rule for ASCs and hospital outpatient departments, which could add cardiac catheterization procedures to the ASC covered list.
Sept. 4, 2018
CMS releases 2019 proposed payment rule. CMS proposed several updates to ASC payments in the 2019 proposed payment rule, issued July 25. One of the key changes for ASCs would be to broaden the definition of device-intensive procedures, adding around 131 procedures for Medicare beneficiaries in the ASC setting.
Sept. 17, 2018
CMS considers nixing 'burdensome' ASC, HOPD requirement.CMS proposed eliminating "unnecessary, obsolete or excessively burdensome" Medicare regulations for ASCs and other healthcare facilities. The proposed rule includes a provision to scale back hospital outpatient and ASC requirements for conducting comprehensive medical histories and physical assessments. The agency proposes replacing comprehensive medical history and physical assessment regulations with requirements that defer to the ASC's policy and/or physicians' judgement.
Nov. 3, 2018
CMS decides ASCs will receive a 2.1 percent increase in 2019 Medicare reimbursement.CMS released the 2019 final payment rule for hospital outpatient surgery departments and ASCs, including an average rate adjustment on procedures. ASCs will receive a 2.1 percent reimbursement rate increase on average per procedure. HOPDs will receive a 1.35 percent average rate increase in 2019. "I think these changes will incentivize physician owners to bring more Medicare cases to the ASC, particularly device-intensive procedures," said William Prentice, CEO of ASCA.
Nov. 6, 2018
CMS final rule implements site-neutral payments, AHA files legal challenge.The American Hospital Association wasn't happy about CMS' plans to issue site-neutral payments for outpatient care, and the organization planned to file a legal challenge against the agency's final rule. Under the 2019 final rule, CMS will reimburse physicians at hospital-owned off-campus clinics "at a rate equivalent to that for physicians in the community who are not affiliated with a hospital." Previously, hospital-owned off-campus clinics received a higher rate than non-affiliated clinics. The new policy also cuts Medicare reimbursement to the off-campus sites by around 60 percent, and potentially saves Medicare $380 million in 2019. Copays would decrease to $16 per visit regardless of the site of service.
Nov. 13, 2018
CMS to pay separately for Exparel, non-opioid pain management at ASCs in 2019.The CMS 2019 final payment rule for hospital outpatient surgery departments and ASCs included an average 2.1 percent reimbursement rate increase per procedure for ASCs, as well as a new code for non-opioid pain management drugs.
Nov. 28, 2018
CMS posts payments for ASCs vs. HOPDs. CMS paved the way for price transparency between ASCs and hospital outpatient departments with a new tool that reveals the average payments for select procedures in both settings. The Procedure Price Lookup tool includes the national average payments to HOPDs and ASCs, as well as the average copay Medicare beneficiaries without supplemental insurance would pay in both settings.