American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

CMS Announces Slight Increase in ASC Payments

CMS released the final rule for payments to ambulatory surgery centers (ASCs) and hospital outpatient departments, which includes increases in payment rates for 2012. Payments to ASCs will increase by 1.6 percent and payment rates under the outpatient protective payment system (OPPS) will increase by 1.9 percent, effective Jan. 1, 2012.

AGA, ASGE and ACG provided recommendations to CMS during the public comment period regarding the new quality reporting program for ASCs. We are pleased that CMS considered our comments regarding the reporting period and measures for the new program, and included several of our recommended modifications. CMS initially proposed a reporting period for quality measures beginning Jan. 1, 2012, for the calendar year (CY) 2014 payment adjustment. Based on comments that this timeline was too aggressive, CMS modified the reporting period to begin Oct. 1, 2012.

Additional modifications related to measures selection for ASC quality reporting include:

• CMS adopted five quality measures beginning in CY 2012 for the CY 2014 payment determination. Four outcome measures and one surgical infection control measure will be reported by ASCs on Medicare claims using quality data codes.
• CMS added two structural measures for reporting beginning in CY 2013 for the CY 2015 payment determination — one for safe surgery checklist use and one for ASC facility volume data on selected ASC surgical procedures. CMS will collect volume data in six broad categories, one of which is a gastrointestinal category. CMS will work with stakeholders prior to public reporting of the volume information to ensure the information made available to the public is meaningful.
• One national health-care safety network infection control measure — influenza vaccination coverage among health-care personnel — will be added in CY 2014 for the CY 2016 payment determination. Recognizing the potential challenges faced by ASCs in collecting this data, CMS changed the proposed initial reporting period so that ASCs have enough time to prepare for the measure. The reporting period for the CY 2016 payment determination will now begin Oct. 1, 2014, and continue through March 31, 2015.

Review the final rule for the OPPS and the ASC payment system. The final rule will appear in the Nov. 30, 2011, Federal Register. CMS will accept comments on issues open for comment until Jan. 3, 2012, and will respond to them in the CY 2013 rule.

Continue to read AGA eDigest and the AGA Washington Insider for more information on what GIs need to know about the final rule.