Looking back at 2018: What a year for ASCs!
As we near the end of the year, let's look back at some of the biggest developments affecting the ASC industry in 2018. And there were many of them.
1. Medicare final rule delivers big wins. The Centers for Medicare & Medicaid Services (CMS) released the 2019 final payment rule for ASCs and hospital outpatient departments (HOPDs) in November. It was hailed as a huge success for surgery centers, with Ambulatory Surgery Center Association (ASCA) CEO Bill Prentice saying, in an ASCA press release, "We applaud CMS leadership for listening to the ASC community and adopting some long asked for policy changes … These changes are a strong signal that this Administration values the role ASCs can play in bending the Medicare cost curve while maintaining quality and safety for beneficiaries."
Highlights of the final rule include the following:
• CMS will now use the hospital market basket, which has long been
the manner in which HOPD payments received updates, for ASCs as well.
This change has been approved from calendar year (CY) 2019 through CY
2023. ASCs were receiving payment adjustments based on the Consumer Price
Index for All Urban Consumers, or the CPI-U, which focuses on broad consumer
price changes and tended to be lower than the hospital market basket.
• CMS reduced the threshold definition of device-intensive procedures in ASCs from 40% to 30%. What this means, as Prentice notes, is that "… if the device portion of the overall procedure equals 30% or more of the total cost of the procedure in the HOPD setting, the total device cost will be included in the reimbursement rate when the procedure is performed in an ASC." The decision effectively adds 124 device-intensive procedures to the 2019 ASC Medicare-approved procedures list.
• CMS added 12 cardiac catheterization procedures to the approved procedures list.
• CMS announced the removal of two measures — "ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel," beginning with the CY 2020 payment determination, and "ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use," beginning with the CY 2021 payment determination.
• CMS suspended data collection for four measures from the ASC Quality Reporting Program: "ASC-1: Patient Burn," "ASC-2: Patient Fall," "ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant," and "ASC-4: All-Cause Hospital Transfer/Admission."
2. Costs remain a major patient concern. One in five: That's how many people said, over a three-month period, that they postponed, delayed, or canceled a healthcare service (e.g., surgical procedure) because of cost, according to a recent IBM Watson-NPR Health Poll. One in four people, over the three-month period, said they had difficulty paying for a healthcare service.
For the past several years, patients have increasingly struggled to cover their portion of healthcare services. As noted in a Becker's ASC Review article, the average out-of-pocket costs for patients increased 11% during 2017, rising from $1,630 in the fourth quarter of 2016 to $1,813 in the fourth quarter of 2017. Another eye-opening statistic from that article: from 2012 to 2016, outpatient surgery prices increased 19%, reaching an average cost per surgery of more than $4,700.
The challenge of patients paying for their care isn't going away, and it will probably get worse before it gets better. ASCs must be prepared to help patients cover their costs and receive the critical care they need. A new and effective way to do so is to offer healthcare installment loans.