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
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
• 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
• 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.
Click to Read More