CMS Releases Proposed Rule for 2019 ASC Payment

2019 ASC Conversion Factor Projected at $46.500 for
ASCs Meeting Quality Reporting Requirements

CMS Proposes to Use Hospital Market Basket Rather than CPI-U to Update Payment Rate Following ASCRS and
Ophthalmic Community Advocacy

On July 25th, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2019 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule. The rule has a 60-day comment period, and ASCRS will be providing comments.  

ASC Conversion Factor

Following ASCRS and ophthalmic community advocacy, CMS is proposing to update ASC payment rates using the hospital market basket rather than the consumer price index-urban (CPI-U) for 2019 through 2023. CMS notes that the proposal will promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting. ASCRS and the ophthalmic community have long sought this change and will support the proposal in our comments.

For CY 2019, CMS proposes to adjust the CY 2018 ASC conversion factor ($45.575) by the wage adjustment budget neutrality factor of 1.0003 in addition to the MFP-adjusted hospital market basket update factor of 2.0%, which results in a proposed CY 2019 ASC conversion factor of $46.500 for ASCs meeting the quality reporting requirements. 

For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2018 ASC conversion factor ($44.663) by the wage adjustment for budget neutrality factor of 1.0003 in addition to the quality reporting/MFP-adjusted hospital market basket update factor of 0%, which results in a proposed CY 2019 ASC conversion factor of $45.589 for ASCs not meeting the quality reporting requirements.

ASC Quality Reporting Program (ASCQR)

As part of its Meaningful Measures initiative to reduce administrative burden, CMS is proposing to eliminate several measures, including the ASCRS-opposed ASC-11, Cataracts: Improvement in Patient's Visual Function within 90 Days, from the ASCQR measure set for 2021 and 2022 payment determination and subsequent years. CMS notes that the measures proposed for removal are either topped out, or the costs associated with the collection of the measure outweigh the benefits of the continued use of the measure.

For 2020 payment, CMS proposes removing the following measure:

• ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel

For 2021 Payment, CMS proposes removing the following measures:

• ASC-1, Patient Burn;
• ASC-2, Patient Fall;
• ASC-3, Wrong Site, Wrong Side, Wrong Procedure, Wrong Implant;
• ASC-4, All-Cause Hospital Transfer/Readmission;
• ASC-9, Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients;
• ASC-10, Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps-Avoidance of Inappropriate Use; and
• ASC-11, Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery. 

Separate Payment for Non-Opioid Pain Management Drugs that Function as a Supply

To combat the opioid crisis, CMS is proposing to pay separately at average sales price (ASP) plus 6% for non-opioid pain management drugs that function as a supply when used in a covered surgical procedure performed in an ASC. 

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.