Ambulatory Surgery Center Resources

2016 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM PROPOSED RULE RELEASED

2016 ASC Conversion Factor Projected at $44.605 for
Those Meeting Quality Reporting Requirements 

On July 1, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2016 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 2016, CMS proposes to adjust the CY 2015 ASC conversion factor ($44.058) wage adjustment budget neutrality factor of 1.0014 in addition to the MFP-adjusted CPI-U update factor of 1.1%, which results in a proposed CY 2016 ASC conversion factor of $44.605 for ASCs meeting the quality reporting requirements.

For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2015 ASC conversion factor ($44.058) by the wage adjustment for budget neutrality factor of 1.0014 in addition to the quality reporting/MFP-adjusted CPI-U update factor of -0.9%, which results in a proposed CY 2016 ASC conversion factor of $43.723 for ASCs not meeting the quality reporting requirements.

ASC Quality Reporting Program (ASCQR)

CMS is not proposing to add any new measures to the program in this proposed rule, but is requesting comment o n two outcome measures for future consideration. The two measures are:

  • Normothermia Outcome, which assesses the percentage of patients having surgical procedures under general or neuroaxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit.
  • Unplanned Anterior 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).

Corneal Tissue

For CY 2016, CMS is proposing to limit the separate payment policy for corneal
tissue acquisition costs in the hospital outpatient department and ASC to only corneal tissue that is used in a corneal transplant procedure. In the ASC, CMS would include corneal tissue procurement as a covered ancillary service only when it is integral to the performance of a corneal transplant procedure that is an ASC covered surgical procedure, and pay separately for this service under the ASC payment system.  This proposal would mean that CMS would not make separate payment for corneal tissue when used in any non-transplant procedure.  Therefore, CMS would make packaged payment for all tissues used as patch grafts in glaucoma shunt surgery. 

Newness Criteria for New Technology IOL (NTIOL)

CMS is proposing that, beginning in CY 2016, any application for a new NTIOL class must fulfill an additional criterion.  CMS proposes that beginning January 1, 2016, an NTIOL application will only be evaluated by CMS for a new IOL class if the IOL has received initial FDA premarket approval within the 3 years prior to the NTIOL application submission date.

Separately Payable Drugs Proposed for Unconditional Packaging

CMS is proposing to package payment for four drugs based on their primary function as a supply in a surgical procedure, which typically means that the drug or biological is integral to, dependent on, or supportive of a surgical procedure. These drugs include HCPCS code J7315, mytomycin ophthalmic, 0.2mg for glaucoma surgery to be packaged in 2016 and HCPCS code C9447 injection, phenylephrine and ketorolac, 4 ml vial for cataract surgery, to be packaged in 2018.  CMS notes that C9447, that would otherwise be packaged in CY 2016 currently has pass-through payment status. Therefore, they are not proposing to package HCPCS code C9447 until CY 2018, after its drug pass-through payment status has expired.

Proposed 2016 Payment Rates 

 

HCPCS

Short Description     

Proposed 2016 Payment Rate

66984     

Cataract surg w/iol, 1 stage

$971.01

66982

Cataract surgery, complex

$971.01

66821

After cataract laser surgery

$250.77

15823

Revision of upper eyelid

$782.37

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

 

 

 

2015 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM PROPOSED RULE RELEASED

2015 ASC CONVERSION FACTOR PROJECTED AT $43.918

ASC-11 CATARACTS - IMPROVEMENT IN PATIENT'S VISUAL FUNCTION WITHIN 90 DAYS FOLLOWING SURGERY CHANGED FROM REQUIRED TO VOLUNTARY

On July 3, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule [CMS-1613-P]. ASCRS reviewed the proposed rule that updates rates paid under the ASC PPS, which will be published in the Federal Register on July 14, 2014. Updates include changes to the conversion factor and updates to the ASC QR program.

ASC Conversion Factor

For CY 2015, CMS proposes to adjust the CY 2014 ASC conversion factor ($43.471) by the wage adjustment for budget neutrality of 0.9983 in addition to the MFP-adjusted update factor of 1.2 percent, which results in a proposed CY 2015 ASC conversion factor of $43.918 for ASCs meeting the quality reporting requirements.

For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2014 ASC conversion factor ($43.471) by the wage adjustment for budget neutrality of 0.9983 in addition to the quality reporting/MFP-adjusted update factor of -0.8 percent, which results in a proposed CY 2015 ASC conversion factor of $43.050 for ASCs not meeting the quality reporting requirements.

ASC-11 Cataracts -- Improvement in Patient's Visual Function Within 90 Days Following Cataract Surgery (NQF #1536

CMS proposes to change ASC-11 from required to voluntary reporting. Following advocacy from ASCRS and the ophthalmic community, CMS delayed implementation of this measure in 2014 and is now acknowledging the operational difficulty of data collection for this measure. Therefore, the proposed rule for CY 2015 would remove ASC-11 from the CY 2016 payment determination measure set and ASCs would not be subject to a payment reduction with respect to this measure in CY 2016. Because the agency continues to believe the measure addresses an area of care that is not adequately addressed in the current measure set--and the measure is intended to facilitate coordination of care--the measure is retained for voluntary data collection and submission  for the CY 2017 and following years' ASCQR measure sets.

Impact of CY 2015 Payment Update on Ophthalmology

Estimated Impact of the CY 2015 Update to the ASC Payment System on Aggregate CY 2014 Medicare Program Payments by Surgical Specialty:

Surgical Specialty group

Estimated CY 2014 ASC Payments (in millions)

Estimated CY 2014 Percent Change

Eye and ocular adnexa

$1,556

-2%

Estimated Impact of Update to CY 2014 ASC Payment System on Aggregate Payments for Selected Procedures

HCPCS

Short Description

Estimated CY 2014 ASC Payments (in millions)

Estimated CY 2014 Percent Change

66984

Cataract surg w/iol, 1 stage

$1,132

-2%

66982

Cataract surgery, complex

$93

-2%

66821

After cataract laser surgery

$63

2%

15823

Revision of upper eyelid

$35

1%

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

 

 

 

 

ASC/Hospital Outpatient Department Quality Measure 11 (Cataract Outcome – Visual Function Improvement) Delayed Until January 1, 2015 As a result of efforts by ASCRS, the American Academy of Opthalmology (AAO), the Outpatient Opthalmic Surgery Society (OOSS) and the Ambulatory Surgery Center Association (ASCA), Measure ASC-11: Cataracts- Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (NQF #1536) has been delayed until January 1, 2015.

View the new ASC Specifications Manuel for more details.

CMS announced that it will delay the implementation of this measure, noting that it recognizes the operational difficulties with this specific measure. CMS intends to issue proposals regarding data collection for this measure in the upcoming CY 2015 OPPS/ASC proposed rule with comment period. As a result of the efforts of ASCRS both Senator Sherrod Brown (D-OH) and Senator Rand Paul (R-KY) sent letters to CMS urging the agency to withdraw the measure. ASCRS, AAO, OOSS and ASCA also met with CMS on multiple occasions to voice our opposition to this measure. Please note, this does not affect the data collection period for any other ASC Quality Reporting Program Measure.

COMBINED HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS) AND AMBULATORY SURGERY CENTER (ASC) PROSPECTIVE PAYMENT SYSTEM (PPS) FINAL RULE RELEASED

ASC PAYMENT RATES 2014

For ASCs that meet the quality reporting requirements, ASC payment rates will increase by 1.2 percent in 2014 (or a conversion factor of $43.471).  This represents a 0.3 percent increase over the proposed 2014 payment rate update of 0.9 percent. The increase is based on a projected rate of inflation based on the Consumer Price Index - Urban (CPI-U) of 1.7 percent minus a 0.5 percent productivity adjustment. For ASCs that do not meet the quality reporting requirements, the conversion factor is $42.612.   

ASC QUALITY REPORTING (ASCQR) PROGRAM

In the 2014 proposed rule CMS included four new measures for ASCs to report in 2014.  Two of them were ophthalmology measures:

  • Complications within 30 days following Cataract Surgery Requiring Additional Surgical Procedures (NQF #0564)
  • Cataracts: Improvement in patient's visual function within 90 days following cataract surgery (NQF #1536)

ASCRS, along with AAO, OOSS, and ASRS strongly opposed these two ophthalmology measures, and asked that they be withdrawn.  

CMS withdrew one of the two measures - Complications Within 30 days Following Cataract Surgery Requiring Additional Surgical Procedures.  Unfortunately, the agency retained measure NQF #1536 regarding improvement in visual function within 90 days of cataract surgery.  

However, ASCs will not be required to collect and report data on all patients for this measure. Instead, ASCs can collect information on a sample of eligible patients, with minimal case number requirements.  Sampling specifications for this measure will be published next month in the ASCQR Specifications Manual on the QualityNet website.  

Link to Final Rule 

We will provide more detailed information in future additions of Washington Watch Weekly.  For more information please contact Ashley McGlone, Manager of Regulatory Affairs, at amcgone@ascrs.org.