CMS Changes Payment Structure for Ambulatory Surgical Centers
by Barbara Kram, Editor | July 23, 2007
The government wants to
pay the same amount for
equivalent services regardless
of the healthcare setting
pay the same amount for
equivalent services regardless
of the healthcare setting
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule revising the payment system for services furnished to people with Medicare in ambulatory surgical centers (ASCs) to better align payments for similar services furnished in a hospital outpatient department (HOPD) or a physician's office. CMS also issued a proposed rule that would update Medicare payment for services in HOPDs under the Outpatient Prospective Payment System (OPPS) and would set new payment rates for ASCs under the revised system effective for services in calendar year (CY) 2008.
The ASC final rule expands beneficiary access to surgical procedures in ASCs and implements steps to make ASC payments more accurate, while aligning payments across Medicare's payment systems to encourage efficient and appropriate choices of outpatient settings for ambulatory surgical procedures. CMS expects to make payments of almost $3 billion in CY 2008 to the approximately 4,600 ASCs that participate in Medicare.
"The system we are announcing will promote the goals of quality and efficiency in care furnished to people with Medicare in ambulatory surgical centers," said CMS Acting Administrator, Leslie V. Norwalk, Esq. "In addition, this revised system will take a major step toward eliminating financial incentives for choosing one care setting over another, thus assuring that patients' needs come first."
The proposed OPPS/ASC rule, published concurrently with the ASC final rule, would implement new steps to encourage more efficient care in hospital outpatient departments by providing hospitals with greater flexibility to manage their resources. The proposal also would ensure appropriate payment for high quality hospital outpatient services under the hospital Outpatient Prospective Payment System (OPPS). The reforms included in this proposed rule are intended to encourage quality and constrain rapid and accelerating growth in Medicare volume and expenditures for hospital outpatient services.
"As the number of services provided in hospital outpatient setting continues to increase annually," said Ms. Norwalk, "we are committed to working with hospitals to ensure the care provided to beneficiaries is appropriate, cost-effective and high quality. Today's proposed rule includes proposed hospital quality measures specific to hospital outpatient care, following the quality measures that have been successfully implemented in the hospital inpatient setting. In addition, this rule's proposal to increase the size of the OPPS payment bundles will give hospitals the flexibility to manage their resources in the most efficient way possible."
The ASC final rule expands beneficiary access to surgical procedures in ASCs and implements steps to make ASC payments more accurate, while aligning payments across Medicare's payment systems to encourage efficient and appropriate choices of outpatient settings for ambulatory surgical procedures. CMS expects to make payments of almost $3 billion in CY 2008 to the approximately 4,600 ASCs that participate in Medicare.
"The system we are announcing will promote the goals of quality and efficiency in care furnished to people with Medicare in ambulatory surgical centers," said CMS Acting Administrator, Leslie V. Norwalk, Esq. "In addition, this revised system will take a major step toward eliminating financial incentives for choosing one care setting over another, thus assuring that patients' needs come first."
The proposed OPPS/ASC rule, published concurrently with the ASC final rule, would implement new steps to encourage more efficient care in hospital outpatient departments by providing hospitals with greater flexibility to manage their resources. The proposal also would ensure appropriate payment for high quality hospital outpatient services under the hospital Outpatient Prospective Payment System (OPPS). The reforms included in this proposed rule are intended to encourage quality and constrain rapid and accelerating growth in Medicare volume and expenditures for hospital outpatient services.
"As the number of services provided in hospital outpatient setting continues to increase annually," said Ms. Norwalk, "we are committed to working with hospitals to ensure the care provided to beneficiaries is appropriate, cost-effective and high quality. Today's proposed rule includes proposed hospital quality measures specific to hospital outpatient care, following the quality measures that have been successfully implemented in the hospital inpatient setting. In addition, this rule's proposal to increase the size of the OPPS payment bundles will give hospitals the flexibility to manage their resources in the most efficient way possible."
