Full article reprinted from "The Gray Sheet" - July 13, 2009
The number of procedures performed in freestanding ambulatory surgical centers rather than general hospitals could rise next year under a July 1 CMS outpatient payment proposal. Find out more...
The number of procedures performed in freestanding ambulatory surgical centers rather than general hospitals could rise next year under a July 1 CMS outpatient payment proposal.
CMS suggests adding 28 procedures to the list of ambulatory surgical center (ASC) covered surgical procedures.
The proposed additions are part of a four-year phase-in of a restructured payment system for ambulatory surgical centers announced in 2007. That year, CMS finalized a policy for ASCs aimed at keeping reimbursement disparities among various care settings from influencing where medical procedures are performed (1 'The Gray Sheet' July 23, 2007).
In 2008, the first year of the phase-in, the agency added over 800 surgical procedures to the list of covered ASC procedures.
In the 2010 Outpatient Prospective Payment System proposal, CMS explains that the proposed policy and payment rate changes for ambulatory surgical care centers are intended to ensure greater patient access to care.
The policy is designed to ensure that when services can be performed in a variety of settings, "the choice of the setting is based on the patient's needs, rather than payment incentives," says CMS in a July 1 press release.
CMS estimates it will spend $31.5 billion on outpatient payments in 2010, and projects a market basket update of 2.1% for outpatient departments. Ambulatory surgical center payments should top $3.4 billion next year, the agency projects.
Changes Proposed For 2010 ASC Procedure List
Two procedures that CMS recommends adding to the ASC coverage list received new CPT codes effective July 1 (percutaneous sacral augmentation including the use of a balloon or mechanical device and involving unilateral injection; and the same procedure involving bilateral injections).
The Medicare agency regularly reviews new procedures and those for which there are coding revisions to see whether they fit criteria for ASC-covered procedures or ancillary services.
An additional 26 procedures that would receive the ASC go-ahead under the proposal had been excluded from the same list for 2009 because CMS thought they fell outside the definition of ASC procedures, which are considered relatively low risk and unlikely to require an overnight stay.
Among these 26 procedures are repair of venous blockage, repair of arterial blockage, removal of kidney stone, repair of ureter lesion and repair of tibia.
In a comprehensive review of procedure codes to determine which surgical procedures should be included within the ASC list, CMS says, it discovered that the volume and utilization data for percutaneous transluminal balloon angioplasty of the brachiocephalic trunk or branches "indicate that it is most frequently performed in outpatient settings."
However, CMS found that the remaining 197 procedures that would still be excluded from the ambulatory surgical center coverage list could be expected to require an overnight stay or would continue to pose significant safety risks to beneficiaries if provided in the freestanding centers, and thus were again left off the proposed list for 2010.
"Patient safety and health outcomes continue to be important to us as more health care moves to the ambulatory care setting," the CMS proposal states.
"Therefore, as we gain additional experience with the ASC payment system, we are interested in any information the public may have regarding the comparative patient outcomes of surgical care provided in ambulatory settings," including hospital outpatient departments, ambulatory surgical settings and physicians offices, "particularly with regard to the Medicare population," the agency continues.
With the growth of physician-owned specialty hospitals in recent years, concerns have arisen that physician self-referrals could lead to overutilization of procedures without a corresponding increase in the quality of care (2 'Health News Daily' Sept. 8, 2008).
- Monica Hogan
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