Image by Mildred Rios from PixabayThe U.S. Centers for Medicare & Medicaid Services (CMS) released its 2025 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments last week.
The headliner from CMS was its proposed 2.6% effective payment update for next year, a figure based on a 3% inflation update plus a 0.4% productivity reduction. As it pertains to that update, CMS listened to industry feedback and mirrored proposed payment changes for ASCs and hospital outpatient departments (HOPDs).
“Of note, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025,” the Ambulatory Surgery Center Association noted in a takeaways post about the proposed payment rule.
Generally, the proposed payment rule was fairly straightforward with few true surprises.
In addition to the modest payment update, for instance, CMS proposed multiple changes to the ASC Quality Reporting Program (ASCQR). The agency also included several policies shaped to address health disparities and expand access to behavioral health care, two big themes for CMS under the Biden-Harris administration.
One area that has already received some industry criticism, however, is how CMS handled proposed changes to the ASC covered procedures list for next year.
Specifically, CMS proposed to add 20 medical and dental surgical procedures to the ASC covered procedures list for 2025.
Changes to the ASC covered procedures list included in CMS’ proposed payment rule for CY 2025.
But 18 codes that ASCA submitted for consideration did not make it into the proposed payment rule for 2025.
Prior to a March 1 deadline, ASCA had submitted 16 cardiovascular codes and two spine codes for consideration. In last week’s proposed rule, CMS did not even mention that the procedures had been submitted for consideration, according to ASCA.
“It is disheartening that CMS established a new, supposedly more transparent process for submitting procedure codes that could be added to the ASC Covered Procedures List, yet proceeds in this proposed rule to ignore the 18 cardiac and spine codes we submitted,” ASCA CEO Bill Prentice said in the organization’s takeaways post. “Medicare beneficiaries would have more access to the care they need if the agency simply relied on the clinical expertise of surgeons who safely perform these procedures and who are best positioned to know where they can be performed.”
Cardiovascular and spine surgeries have increasingly moved into the ASC setting – and the trend is expected to continue moving forward.
“Hospitals, understandably, have to handle a wide range of medical issues and cannot be as hyper-focused on one area of medicine,” Dr. Luke Macyszyn, a neurosurgeon with California-based DISC Sports & Spine Center, previously told Ambulatory Surgery Center News. “In our ASC, we don’t have to jump through hoops to change equipment between cases or manage various skill sets. We excel at one thing — spine and orthopedics — at a very high level.”
In its proposed payment rule for 2025, CMS did suggest more covered procedures will be added to the ASC list in the future.
“We encourage interested parties to submit procedure recommendations to be added to the ASC CPL, particularly if there is evidence that these procedures meet our criteria and can be safely performed in the ASC setting,” CMS wrote in its over 980-page proposed payment rule. “We expect to continue to gradually expand the ASC CPL, as medical practice and technology continue to evolve and advance in future years.”
