Here are five key points:
1. U.S. Representatives Devin Nunes, R-Calif., and John Larson, D-Conn., introduced the legislation on March 30, 2017.
2. The bipartisan legislation addresses an issue that permits CMS to use different inflation measures for ASC and hospital outpatient department rates. Medicare reimburses ASCs at 49 percent the amount paid to HOPDs for the same services, on average.
3. ASCA CEO William Prentice commented the reimbursement structure is unsustainable, noting Medicare reimburses ASCs at a lower rate than HOPDs, despite the same delivery of outpatient surgical care.
4. The proposed bill also mandates CMS to publish quality data for patients to compare quality across service sites, as well as asks CMS to appoint an ASC representative to its Hospital Outpatient Payment advisory panel.
5. The legislation also demands CMS report which criteria excludes a procedure from the ASC approved list.
“Without a fix, the disparity between ASC and HOPD payments will continue to widen, potentially reducing access to ASCs and leaving Medicare beneficiaries with only higher cost options for their care and increased Medicare program expenses,” said Mr. Prentice.
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