cost HOPDs to lower-cost ASCs.
"The changes included in this year's rule are among the most signifi-
cant I have seen in my 8 years with ASCA," says William Prentice,
CEO of the Ambulatory Surgery Center Association. "Overall, I would
say they demonstrate greater recognition of the quality and value
ASCs provide than we have seen in any previous rulemaking."
Key points of the 1,182-page rule:
Equal financial footing. Let's start with a move that could be a
harbinger of site neutrality. CMS will use the same inflation rate
to update payments in ASCs as it does in HOPDs, a change ASCA has
fought for over the last decade. On average, Medicare pays ASCs less
than half (47%) of HOPD rates for the same procedures. Many feel this
growing divide exists, in part, because CMS uses different measures
to update ASC and HOPD payments.
CMS had been using the Consumer Price Index (CPI) to update ASC
payment rates, a measure that examines the weighted average of
prices of a basket of consumer goods and services. Meanwhile, it
bases HOPD payment updates on the hospital market basket inflation
factor, a measure directly related to the increasing costs of providing
medical care that are common to both hospitals and ASCs.
"ASCs use the same staff, services and supplies as hospital outpa-
tient departments," says Mr. Prentice, "so it only makes sense to apply
the same inflation rate for our yearly updates."
CMS will use the hospital market basket to update ASC payments for
the 5-year period of 2019 to 2023.
Device-intensive procedures. As you know, the cost of a device
can be a large part of the overall cost of some procedures. If an
ASC isn't reimbursed separately for an expensive device, it becomes
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