2015 AMBULATORY SURGICAL CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM FINAL RULE RELEASED 2015 ASC CONVERSION FACTOR $44.071 ASC-11 CATARACTS - IMPROVEMENT IN PATIENT'S VISUAL FUNCTION WITHIN 90 DAYS FOLLOWING SURGERY CHANGED FROM REQUIRED TO VOLUNTARY
On October 31, 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 final rule [CMS-1613-FC].  ASCRS reviewed the rule that updates rates paid under the ASC PPS, which will be published in the Federal Register on November 10, 2014.
Updates include changes to the conversion factor and updates to the ASCQR program. ASC Conversion Factor For CY 2015, CMS is adjusting the CY 2014 ASC conversion factor ($43.471) by the wage adjustment for budget neutrality of 0.9998 in addition to the MFP-adjusted update factor of 1.4 percent, which results in a CY 2015 ASC conversion factor of $44.071 for ASCs meeting the quality reporting requirements. This payment update is higher than the 1.2 percent rate CMS published in the proposed rule. For ASCs not meeting the quality reporting requirements, CMS is adjusting the CY 2014 ASC conversion factor ($43.471) by the wage adjustment for budget neutrality of 0.9998 in addition to the quality reporting/MFP-adjusted update factor of -0.6 percent, which results in a CY 2015 ASC conversion factor of $43.202 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 is finalizing their proposal 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 final rule for CY 2015 removes ASC-11 from the CY 2016 payment determination measure set and ASCs are not 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--based on CY 2015 reporting--and following years' ASCQR measure sets. Reclassification of Ophthalmic Procedures Within APCs Despite comments from ASCRS and the ophthalmic community opposing it, CMS finalized its proposal to restructure all Ambulatory Payment Classifications (APCs) for ophthalmology. CMS believes that the existing set of 24 APCs unnecessarily separated, from a clinical and resource similarity perspective, ophthalmic procedures based on disease state or traditional sub-divisions within ophthalmic surgery. CMS asserts that APC groupings were never intended to track traditional ophthalmology subspecialty divisions, such as cornea surgery, retina surgery, or glaucoma surgery, and so feels that the new set of 13 larger groupings are more consistent with a prospective payment system. 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 email@example.com .