OR Manager - February 2019 - 31

AMBULATORY
SURGERY CENTERS
2019 Medicare final payment rule brings big wins for ASCs
T
he holiday spirit got off to a good
start at ambulatory surgery centers
(ASCs) across the country
with the November 2, 2018, announcement
of the Centers for Medicare &
Medicaid Services' (CMS) 2019 Ambulatory
Surgical Center Payment System
and Quality Reporting (ASCQR) Program
Final Rule. Several significant changes
ASCs had long lobbied for were included
in the final rule.
The most beneficial change was
CMS's decision to base its annual inflation
update for ASC payments on the
hospital market basket and not the Consumer
Price Index for All Urban Consumers
(CPI-U).
" This change will help to promote 'site
neutrality' between hospitals and ASCs
and encourage the migration of services
from the hospital setting to the lowercost
ASC setting, " CMS said when it announced
the final rule on its website.
" The changes included in this year's
rule are among the most significant I
have seen in my 8 years with ASCA, "
says William Prentice, chief executive
officer of the Ambulatory Surgery Center
Association (ASCA). " We have fought for
this change [to the market basket] over
the last decade and appreciate that it
was adopted. It is a more realistic indicator
of rising costs in the ASC space. "
Leveling the playing field
ASCs were the only brick-and-mortar
healthcare facilities to receive inflation
rates based on the CPI-U, even though
ASCs use the same staff, services, and
supplies as hospital outpatient departments
(HOPDs), according to Kara Marshall
Newbury, ASCA regulatory counsel.
" This decision will slow
the growing disparity
between ASC and
HOPD payment rates, "
she says.
Kara
Marshall
Newbury
" This is the first time
[CMS] has given us a
significant boost, " notes
Jeffrey Flynn, CASC,
chief executive officer
(CEO) of Gramercy Surgery Center in
New York City. " It is well overdue. Medicare
now seems to be well in tune-as
many commercial payers already are-
that from standpoints such as infection
control and efficiency, ASCs are usually
a better choice than an HOPD. "
The change to the market basket
means that, for 2019, ASC reimbursements
for all covered procedures will
see on average an update of 2.1%. Updates
will vary depending on specialty
and coding.
" The change is based on the hospital
market basket increase of 2.9%
minus a 0.8 percentage point adjustment
for MFP [multifactor productivity], "
according to CMS.
ASCs must prove during the next 5
years that this change will result in a
migration of procedures from HOPDs to
ASCs, leading to savings for CMS and
patients without a worsening of patient
outcomes or satisfaction, Prentice says.
Medicare is asking ASCs to help collect
and report data regarding migration and
savings.
" I think Medicare, by giving us a nice
increase, enables us to perform more
services for its beneficiaries and to
possibly expand services as we look at
efficiency and costs, " says Flynn, vice
president of the New York State Association
of Ambulatory Surgery Centers.
For example, the state association is
bringing independent centers together
under one group purchasing organization
to get better pricing, he notes.
For people over age 65, the change
will offer options that will save on out-ofpocket
costs. " The population is aging,
and Medicare is becoming a larger
payer, " says Andy Poole, CEO of Monticello
Community Surgery Center in Charlottesville,
Virginia.
And for ASCs, the benefit of the
Medicare changes come from " not just
the individual one-off rate increase, but
from the volume that is also behind
it. We're seeing a continued growth of
Medicare as a percentage of patients;
add in the volume component of the
increase, and it increases further in its
significance, " Poole says.
More generous device coverage
More expensive devices, such as some
implants, will be paid by Medicare now
that CMS defines ASC device-intensive
procedures as those with a device offset
percentage greater than 30%, rather
than the previous 40%.
AMBULATORY SURGERY ADVISORY BOARD
Michele Bossi, MSN, RN, Director of Clinical
Operations/ASC Administrator, OSS
Health, York, PA
Ellen Carpenter, BSN, RN, Assistant Director
of the OR, Long Island Jewish Medical
Center, New Hyde Park, NY
Jennifer Dickman, DNP, RN, CPN, Director,
North Surgery Center, UPMC Children's
Hospital of Pittsburgh, Sewickley, PA
Tracy Hoeft-Hoffman, MSN, MBA, RN,
CASC, Administrator, Heartland Surgery
Center, Kearney, NE
Mary Jo Steiert, BSN, RN, Administrator,
Director of Nurses, Lowry Surgery
Center, Denver, CO
30
OR Manager | February 2019
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OR Manager - February 2019

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