CMS ADOPTS PAYMENT POLICY & RATE CHANGES FOR SERVICES IN HOSPITAL OUTPATIENT DEPARTMENTS AND AMBULATORY SURGICAL CENTERS FOR 2010

The Centers for Medicare & Medicaid Services (“CMS”) has announced that most hospitals will receive an inflation update of 2.1 percent in their payment rates for services provided to Medicare beneficiaries in outpatient departments.  Due to a Medicare requirement, CMS will reduce the update by 2.0 percentage points for hospitals that did not participate in quality data reporting for outpatient services or that did not report the quality data successfully, resulting in only a 0.1 percent update for those hospitals. 

CMS also announced that ambulatory surgical centers (“ASCs”) will receive a 1.2 percent inflation update starting January 1, 2010.  CMS projects that the aggregate Medicare payments to more than 4,000 hospitals and community mental health centers in calendar year (“CY”) 2010 will be approximately $32.2 billion, while aggregate Medicare payments to approximately 5,000 ASCs will total $3.4 billion.

The payment updates are included in a final rule with comment period that revises payment policies and updates the payment rates for services provided to beneficiaries during CY 2010 in hospital outpatient departments under the Outpatient Prospective Payment System (“OPPS”) and in ASCs under a revised rate-setting methodology that was established January 1, 2008.

The updated payment rates are meant to ensure that Medicare beneficiaries continue to receive high quality and efficient care in the most appropriate setting.

The CY 2010 OPPS/ASC final rule with comment period will be included in the November 20, 2009 Federal Register.  Comments on designated provisions are due by 5:00 p.m. EST on December 29, 2009.  CMS will respond to comments in the CY 2011 OPPS/ASC final rule.

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CMS Proposes Medicare Payment Increase for ASCs in 2010

CMS recently issued a notice of proposed rulemaking that includes proposals for policy changes and payment rates for services in ambulatory surgical centers (“ASCs”), which would continue the expansion of surgical procedures that Medicare would cover for services performed in ASCs. The proposed rule seeks to make sure that beneficiaries have access to outpatient services in all appropriate settings, while improving the quality and efficiency of service delivery.

Since January 1, 2008, ASCs have been paid under a revised payment system that aligns ASC payment rates with the rates paid for similar services when provided in hospital outpatient departments. The revised system also increases the number and types of surgical services that are covered by Medicare when performed in ASCs.  Calendar year 2010 is the third year of a four-year phase-in of the ASC payment rates calculated under the standard rate-setting methodology and the first year in which CMS is authorized to apply an update to the conversion factor.  CMS is projecting the percentage increase in the Consumer Price Index for All Urban Consumers that would update the ASC conversion factor to be 0.6 percent. Total 2010 payments to ASCs are estimated to be $3.4 billion.

CMS will accept comments on the proposed rule until August 31, 2009, and will respond to comments in a final rule to be issued by November 1, 2009.

To review the proposed rule and for instructions about how to submit comments, go to: http://edocket.access.gpo.gov/2009/E9-15882.htm

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  For more information, contact info@pvwlaw.com

HHS Announces Infection Control Surveys for Ambulatory Surgery Centers

To help prevent serious infections resulting from services performed in ambulatory surgical centers, the Centers for Medicare and Medicaid Services (“CMS”) will use the funds provided in the American Recovery and Reinvestment Act of 2009 (“ARRA”) to implement the nationwide application of a new infection control survey tool developed in consultation with the Centers for Disease Control and Prevention (“CDC”) and a case tracer methodology that tracks a patient’s care from admission to discharge. Additionally, CMS will use the ARRA funds to survey ambulatory surgical centers using this survey application at the rate of approximately once every three years during the national pilot program.

The particular focus on ambulatory surgical centers for this funding was chosen because the available infection control tool was developed for ambulatory surgical centers and because of the likely continuing infection control deficiencies in ambulatory surgical center settings.

The primary use of this money will be to pay for the expansion of ambulatory surgical center surveys (both in quality, time and number) using the new infection control tool and case tracer methodology. The funds will allow states to hire additional surveyors (one to four per state dependent upon ambulatory surgical center growth), which will increase a state’s capacity to maintain expected levels of ambulatory surgical center inspections while building greater capacity to use the improved survey tool nationwide.

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CMS Updates Medicare Conditions for Coverage for ASCs

The long-awaited Final Rule updating Medicare Conditions for Coverage (CFCs) for Ambulatory Surgery Centers (ASCs) has finally been published by the Centers for Medicare and Medicaid Service (CMS).   The Final Rule represents the first major non-payment related update to the ASC CfCs since they were originally published in 1982.  The requirements of the Final Rule are effective for ASCs as of May 18, 2009.

The Final Rule generally focuses on patient rights and patient outcomes.  Among other things, it:

• Bolsters patient rights to disclosure of physician financial interest in the ASC
• Refines the obligations to assess patient pre-operative condition and post-operative condition
• Requires certain ASC governing body actions regarding quality assessment and performance improvement
• Imposes certain infection control requirements
• Requires preparation of a disaster preparedness plan coordinated with state and local authorities

In the Final Rule, CMS ended up backing away from some of the more controversial changes that it had placed in its Proposed Rule.  Among the proposals that drew the most criticism from the ASC community and that CMS either removed or modified in the Final Rule were the following:

• CMS backed away from its proposal to require the surgeon to conduct a “thorough assessment” of all bodily systems on each patient prior to discharge.   The Final Rule requires that a physician or other qualified practitioner, which includes a registered nurse with post-operative care experience, assess the patient in a manner appropriate the the procedure performed and the patient’s individual condition.
• CMS backed away from its proposed “safe transition to home” language, which seemed to burden the ASC with responsibility for ensuring each patient not only have adequate transportation home but actually make it home safely.  The Final Rule generally requires that patients be discharged in the company of a responsible adult. 
• CMS backed away from its proposal to require ASCs providing radiological services to meet the more burdensome coverage conditions applicable to suppliers of portable x-ray services.  The Final Rule requires that the less burdensome hospital conditions for radiology be met.
• CMS backed away from its proposal to redefine ASCs to exclude facilities that keep patients past 11:59 p.m.  Instead, the Final Rule excludes facilities where the expected duration of services exceeds 24 hours.   

© 2009 Parsonage Vandenack Williams LLC

  For more information, contact info@pvwlaw.com