CMS Releases Final Rule for 2017 ASC Payment and Finalizes a 90-Day Meaningful Use Reporting Period in 2016

2017 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM
FINAL RULE RELEASED;
INCLUDES 90-DAY MEANINGFUL USE REPORTING PERIOD FOR 2016

2017 ASC Conversion Factor Finalized at $45.030 for Those Meeting Quality Reporting Requirements

 

Today, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates Final Rule

ASC Conversion Factor

For CY 2017, CMS will adjust the CY 2016 ASC conversion factor ($44.190) by the wage adjustment budget neutrality factor of 0.9996 in addition to the MFP-adjusted CPI-U update factor of 1.9%, which results in a CY 2017 ASC conversion factor of $45.030 for ASCs meeting the quality reporting requirements.

For ASCs not meeting the quality reporting requirements, CMS finalized to adjust the CY 2016 ASC conversion factor ($44.190) by the wage adjustment for budget neutrality factor of 0.9996 in addition to the quality reporting/MFP-adjusted CPI-U update factor of -0.1%, which results in a CY 2017 ASC conversion factor of $44.330 for ASCs not meeting the quality reporting requirements.

Finalized Changes to the EHR/Meaningful Use Incentive Program

In the final rule, CMS finalized several changes to the current EHR/Meaningful Use program.

  • Reporting Period: CMS shortened the 2016 Meaningful Use reporting program for all eligible professionals to any continuous 90-day period between January 1, 2016, and December 31, 2016. 
  • New Participants in 2017: CMS finalized that new participants who have not successfully demonstrated Meaningful Use would be required to attest to Modified Stage 2 by October 1, 2017, to avoid the 2018 payment adjustment. Returning eligible professionals will be reporting through the new Merit-Based Incentive Payment System (MIPS) program in 2017, and thus are unaffected.
  • Significant Hardship Exemption for New Participants transitioning to MIPS: CMS finalized that certain eligible professionals who have (1) not successfully demonstrated Meaningful Use in a prior year, (2) intend to attest to Meaningful Use for an EHR reporting period in 2017, and (3) intend to transition to MIPS and report on measures specified for the advancing care information performance category of MIPS as finalized for 2017, can apply for a significant hardship exception from the 2018 payment adjustment.

ASC Quality Reporting Program (ASCQR)

CMS finalized not to add any new measures for the CY 2018 and 2019 payment determination. However, for CY 2020 payment determination and subsequent years, CMS finalized adding seven measures to the ASCQR measure set. The seven measures are:

  • ASC-13: Normothermia Outcome, which assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia unit.
  • ASC-14: Unplanned Vitrectomy, which assesses the percentage of cataract surgery patients who have an unplanned anterior vitrectomy (removal of the vitreous present in the anterior chamber of the eye).
  • ASC-15(a-e): Five finalized measures that are collected using the Outpatient and Ambulatory Surgical Center Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey, a patient experience or care survey that assesses patients' access to care, interactions with facility staff, and overall experience at the facility.

ASCRS/ASOA supported the inclusion of ASC-13 and ASC-14, but opposed finalizing the ASC-15 survey measures. 

In addition, CMS sought comment in the proposed rule on a quality measure for future consideration that addresses Toxic Anterior Segment Syndrome (TASS), which would assess the number of ophthalmic anterior segment surgery patients diagnosed with TASS within two days of surgery. ASCRS/ASOA supported the inclusion of the measure. CMS responded in the final rule that it will consider the measure for future inclusion in the program.

Corneal Tissue

For CY 2017, CMS will continue its policy to limit separate payment for corneal tissue acquisition costs in the hospital outpatient department and ASC to only corneal tissue that is used in a corneal transplant procedure.

Site Neutral Payment Provisions

For CY 2017, CMS finalized implementing a provision of the Bipartisan Budget Act of 2015, which requires that certain items and services furnished by certain off-campus "provider based departments" (PBDs) will not be considered covered outpatient department services for purposes of Outpatient Prospective Payment System (OPPS) payment, and will instead be paid under an "applicable payment system." For CY 2017, CMS will issue a separate interim final rule establishing a Medicare Physician Fee Schedule (MPFS) as the applicable payment system for the majority of non-excepted items and services furnished in an off-campus PBD.
 
Finalized 2017 Payment Rates

HCPCS

Short Description

Finalized 2017 Payment Rate

66984

Cataract surg w/iol, 1 stage

$976.78

66982

Cataract surgery, complex

$976.78

66821

After cataract laser surgery

$253.68 

15823

Revison of upper eyelid

$770.84 

Additional information will be detailed in upcoming editions of Washington Watch Weekly. For questions, please contact Allison Madson, manager of regulatory affairs, at 703-591-2220 or amadson@ascrs.org.