Brian Gauger is president and CEO of Edina, Minn.-based National Cardiovascular Partners.
Mr. Gauger told Becker's ASC Review what CMS' proposed payment changes in 2020 could mean for ASCs.
Note: Responses were lightly edited for style and clarity.
Question: Can you give a brief overview of what exactly CMS proposed regarding cardiovascular procedures in the ASC setting?
Brian Gauger: The CMS proposal adds three percutaneous coronary intervention procedures and three add-on procedures to the ASC list of covered surgical procedures for [calendar year] 2020. These proposed additions build on the changes CMS made last year, namely updating the definition of "surgery" to include less invasive percutaneous procedures that were previously assigned codes outside of the CPT surgical range, and adding 12 diagnostic cardiac catheterization codes and five related codes for ASC reimbursement in 2019.
If finalized this year, the proposed PCI codes will allow more Medicare beneficiaries to receive both diagnostic and interventional coronary catheterization procedures in the ASC site of service. In addition to more comfort and convenience for patients, this change will create significant savings for the Medicare program and reduce copayments for its beneficiaries.
Q: How could the proposal affect ASCs in a financial sense? What are the details on reimbursement rates for ASC-based cardiovascular procedures?
BG: The addition of the six procedures proposed by CMS would have a significant and very positive impact to the financial success of the ASCs that are performing cardiovascular procedures. It is difficult to quantify an ASC's financial impact without understanding the specific volume and case mix of the individual center.
Q: Do you think there will be any changes made in the final rule, or do you expect it to be finalized as is?
BG: CMS makes a strong case that PCI procedures should be added to the ASC list of covered surgical procedures because they do not pose a significant risk to patient safety when performed in an ASC. CMS also explains that including these procedures for reimbursement is consistent with Medicare's coverage of clinically similar peripheral procedures — procedures that have a history of safe performance in the ASC.
This finding is consistent with National Cardiovascular Partners' experience and data, and we agree that covering these procedures in the ASC will be good for both the Medicare program and its beneficiaries.
Q: What can ASCs do today to prepare for the final rule in 2020?
BG: Adding the cardiology service line to an existing ASC is both challenging and expensive, so having a good understanding of the regulations and requirements for your state is extremely important. One of the first things interested ASCs should do is find committed cardiologists that are willing to do their cases in an ASC setting, because without them, there is no reason to move forward. Other considerations should include the added space that would be involved, the equipment necessary to perform the procedures and the specific staffing needs you will encounter. The best thing you could do is to choose a partner that has extensive knowledge of and experience in the outpatient cardiovascular arena.
Q: What changes are you anticipating from CMS in future OPPS proposals?
BG: We anticipate that CMS will continue to review procedures that meet the new definition of surgery and add even more codes to the ASC list of covered procedures in the coming years.
We believe there are more coronary diagnostic and intervention procedures that are safe in the ASC, and if added, they would allow more Medicare beneficiaries to choose the convenience and savings of an ASC as an alternative to the hospital outpatient setting. CMS is already requesting feedback from stakeholders on graft and atherectomy procedures, which signals that it is considering what it may propose in future rule-making.
Would you like to participate in future Q&As? Email Angie Stewart: astewart@beckershealthcare.com.
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