Congress Proposes ASC Reimbursement Overhaul

A bipartisan proposal in Congress may enact two long-awaited changes in ambulatory surgical center (ASC) reimbursement: Medicare payment updates tied to hospital market and a value-based purchasing program to generate shared savings for the Centers for Medicare & Medicaid Services (CMS) and high-performing ASCs.

The Ambulatory Surgical Center Quality and Access Act of 2011, introduced by Reps. Pete Sessions (R-Texas), John Larson (D-Conn.), Shelley Berkley (D-Nev.) and Bill Cassidy (R-La.), attempts to preserve “patient access to the high quality, cost-effective health care services that” ASCs provide, says the Ambulatory Surgery Center Association in a news release.

Ambulatory Surgical Center CASCC

ASCs are paid based on the Consumer Price Index for all Urban Consumers (CPI-U) rather than the market basket unique to hospitals, which are also paid using the Outpatient Prospective Payment System (OPPS). The association cites a letter from more than 20 lawmakers to the U.S. Department of Health and Human Services (HHS) last year.

HHS proposed the value-based purchasing system (VBP) last year, but told the industry and Congress it did not have the authority to implement it. Under the HHS proposal, proposed to take effect 2015, facilities reporting high levels of quality on specified measures would be rewarded with higher payments. Quality measures that would be considered under the program include patient falls and burns; hospital transfers and admissions; wrong-site, -side, -patient, and -implant surgeries; prophylactic antibiotic administration; surgical site hair removal; surgical site infection; medication administration and reconciliation; and venous thromboembolism measures.

In a report to Congress, HHS Secretary Kathleen Sebelius describes how “… using a continuous quality improvement framework, would reward high-quality ASCs and align with initiatives under other Medicare quality incentive programs.”


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