OR Manager - February 2019 - 32

AMBULATORY
SURGERY CENTERS
This means that if a device needed
to perform a procedure represents more
than 30% of the cost of the overall procedure
in an HOPD, Medicare will incorporate
the full amount of the device
in the payment rate for ASCs, explains
Newbury.
The lower threshold expands the
number of device-intensive procedures
from 153 to 277 in 2019, making it
economically viable for ASCs to perform
more procedures with significant device
costs.
Poole says his center performs many
spinal procedures, some of which use
nerve stimulators that are just above
the 40% threshold. Now that the threshold
has been lowered, there may be
other options for surgeons.
More ASC-payable procedures
Jeffrey Flynn,
CASC
CMS has finalized the
addition of 12 cardiac
catheterization procedures
that were in the
proposed rule now that
it has revised the definition
of surgery in the
ASC payment system to
account for certain surgery-like
procedures assigned codes
outside the CPT surgical range.
CMS is also adding five additional
procedures performed during cardiac
catheterization to the list of ASC covered
surgical procedures.
Covered surgical procedures are
those that are paid separately under
the Outpatient Prospective Payment
System, would not be expected to pose
a significant risk to beneficiary safety,
and would not typically be expected to
require active medical monitoring and
care at midnight following the procedure,
according to CMS.
" Although these procedures are
already being performed on patients
who are not covered by Medicare, in
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2019, we expect to see these procedures
performed for
the first
time
in Medicare beneficiaries in the ASC
setting because of the changes, " Newbury
says.
In addition, CMS's review of a list
of codes, including many spine codes
currently performed in ASCs, found they
can be done safely, effectively, and to
the benefit of the Medicare patient.
These procedures had been added to
the ASC-payable list 3 years prior to the
rule they were engaged in making during
2015 to 2017.
Payment for non-opioid pain
management
When Exparel is used in procedures
performed in an outpatient setting, CMS
will pay for it separately. Exparel, the
only non-opioid pain-relief injectable
used during surgery as a local anesthetic
or for a nerve block, is the only
drug currently approved by the Food and
Drug Administration for that purpose.
When other drugs similar to Exparel
come on the market, they too will then
be reimbursed.
This separate payment removes a
disincentive to using non-opioid pain
relievers, which aligns with healthcare
providers' and policy makers' plans to
reduce the use of opioids across the
country.
Streamlined ASC quality
reporting program
There were many changes to the
ASCQR Program for 2019 and beyond
that ASC administrators need to be
aware of, Newbury says.
For example, CMS is removing certain
measures from the ASCQR Program,
according to the CMS website:
" The removal of these measures is consistent
with the CMS's commitment to
using a smaller set of more meaningful
measures and focusing on patient-centered
outcomes measures, while taking
into account opportunities to reduce
the paperwork and reporting burden on
providers. "
Poole praises the reporting changes:
" You don't want to measure something
that does not provide meaningful data.
It is good to see Medicare adjust these
measures over time as performance
evolves. "
Overall, the final rule will eliminate
a significant number of measures-a
total of six that ASCs are currently required
to report.
Although ASCs do not need to report
on all the same quality measures as before,
participation in the program is still
required. ASCs that do not meet the
2019 reporting requirements will see
reductions in their Medicare payments
in the future, just as before.
What's next?
Andy Poole
" In the short term, to
make the most of the
many changes the
2019 payment rule provides,
ASCs need to
look carefully at the procedures
they perform
and the impact of the
new payment rates on their ASC's bottom
line, " Newbury says. To help with
this process, ASCA members can access
an online rate calculator.
Other resources available from
ASCA include a webinar on quality
reporting measures (https://asca.
sclivelearningcenter.com/MVSite/
MVSearch.aspx?keyword=CMS%20
Quality%20Reporting%20for%20ASCs)
and a list of frequently asked questions
(https://www.ascassociation.
org/federalregulations/qualityreporting/medicare-quality-reporting-faqs).
✥
Janet M. Boivin, BSN, BSJ, RN, is a freelance
healthcare writer in the Boston area.
OR Manager | February 2019 31
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OR Manager - February 2019

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