Ambulatory Surgery Center Resources

2017 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM PROPOSED RULE RELEASED

2017 ASC Conversion Factor Projected at $44.684 for Those Meeting Quality Reporting Requirements 

On July 6, 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 proposed rule

ASC Conversion Factor

For CY 2017, CMS proposes to adjust the CY 2016 ASC conversion factor ($44.190) by the wage adjustment budget neutrality factor of 0.9992 in addition to the MFP-adjusted CPI-U update factor of 1.2%, which results in a proposed CY 2017 ASC conversion factor of $44.684 for ASCs meeting the quality reporting requirements.

For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2016 ASC conversion factor ($44.190) by the wage adjustment for budget neutrality factor of 0.9992 in addition to the quality reporting/MFP-adjusted CPI-U update factor of -0.8%, which results in a proposed CY 2017 ASC conversion factor of $43.801 for ASCs not meeting the quality reporting requirements.

ASC Quality Reporting Program (ASCQR)

CMS is not proposing to add any new measures for the CY 2018 and 2019 payment determination. However, for CY 2020 payment determination and subsequent years, CMS is proposing to add 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 proposed 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.

In addition, CMS is seeking comment 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.

Corneal Tissue

For CY 2017, CMS is proposing to 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 is proposing to implement 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 proposes to use the 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.
 

Proposed 2017 Payment Rates 

 

HCPCS

Short Description     

Proposed 2016 Payment Rate

66984     

Cataract surg w/iol, 1 stage

$964.88

66982

Cataract surgery, complex

$964.88

66821

After cataract laser surgery

$253.08

15823

Revision of upper eyelid

$760.53

 For questions, please contact Allison Madson, manager of regulatory affairs, at 703-591-2220 or amadson@ascrs.org