2022 Proposed Payment Rule: Highlights for the ASC Community

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The Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed payment rule for ambulatory surgery centers (ASC) and hospital outpatient departments (HOPD). The 860 or so pages contain many updates and changes. The list below summarizes the changes causing the most interest for the ASC community.

The Good

  • CMS will continue to use the hospital market basket to update ASC payments for the calendar year (CY) 2021 through CY 2023 as the agency assesses this policy’s impact on volume migration. They have included an increase of ~2.3% on average overall covered procedures.
  • CMS also proposed a positive policy change to device-intensive code calculations. The device offset percentage would be calculated using ASC rates and not the previously used HOPD rates. Any procedure in which the device cost is 30% of the overall ASC procedure rate will receive device-intensive status.

The Bad

  • The good fortune of last year’s changes will be wiped out as CMS proposes removing 258 of the codes added to the ASC-CPL in 2021.
  • They are also proposing to halt the elimination of the inpatient-only (IPO) list (which was to happen over three years.
  • They also want to reverse recent changes to 42 CFR 416.166 by bringing back the general exclusion criteria put in place during 2020 and previous years.

The Mixed Bag

ASCs will see several changes to the Quality reporting metric as well. Some of these changes are welcomed by the ASC community, but some are confusing and burdensome. Let’s break these changes down.

January 2022:

  • Mandatory:
    • Add a COVID-19 Vaccination Coverage Among Health Care Personnel (HCP) measure. If you haven’t used the website in a while, you should log in and make sure you are still set up to submit your data.

January 2023

  • Mandatory:
    • Require and resume data collection for ASC-1, ASC-2, ASC-3, and ASC-4, beginning with the CY 2023 reporting period/CY 2025 payment determination and subsequent years for web-based submissions. These will no longer be claims-based and will require data collection at the center.
    • Require that ASC-11 Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery be mandatory beginning with the CY 2023 reporting period/CY 2025 payment determination and for subsequent years. This won’t be easy to gather. The center will be required to reach out to all the cataract providers for proof of improvement.
  • Voluntary:
    • Use of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-based measures (ASC-15a-e), with voluntary reporting in the CY 2023 reporting period. (No Change)

January 2024

  • Mandatory:
    • Require the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-based measures (ASC-15a-e) beginning with the CY 2024 reporting period/CY 2026 payment determination and for subsequent years.

These changes are just in the proposal state. All comments are due September 17, 2021, through www.regulations.gov. The final rule is usually released towards the end of November. Hopefully, our ASC voices will be heard, and the rule will meet the needs of our patients and our community.

 

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Maura Cash, RN, BSN, CASC

About the Author: Maura Cash, RN, BSN, CASC

Vice President of Clinical Strategies More posts by Maura Cash, RN, BSN, CASC

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