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CMS rulings draw favorable reviews from ophthalmic groups
CMS adds more than 60 ophthalmic procedures to the list that may be performed in ASCs, but concerns still loom.
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Many procedures performed in ASCs could become more accessible once proposed Medicare payment changes take effect, according to the Centers for Medicare and Medicaid Services.
Under a proposed rule issued in late July, Medicare ASC payments would equal 65% of hospital outpatient department rates in 2008, the CMS release said.
The CMS also issued a final rule in July that aligned ASC payments with hospital outpatient department payments and added more than 60 ophthalmic procedures to a list of services that may be performed in ASCs, the release said.
The final rule – published along with the proposed rule – expanded access to ASCs and aligned payments to “encourage efficient and appropriate choices of outpatient settings for ambulatory surgical procedures,” according to the CMS.
Reaction from ophthalmic community
“Overall, CMS got most of the big things right,” OSN Regulatory/Legislative Section Member Michael Romansky, JD, said in a telephone interview. “First of all, all ophthalmic procedures are now on the ASC list. Secondly, cataract, which is the largest-volume procedure in the Medicare program, will go up a bit, even starting in year one, and will continue to increase as the transition unfolds and as cost-of-living adjustments kick in. A number of the retinal procedures increase by hundreds of dollars a case. So by and large, I think ophthalmology did fairly well in the process.”
 William L. Rich |
Mr. Romansky is a consultant and attorney representing the Outpatient Ophthalmic Surgery Society.
William L. Rich III, MD, FACS, American Academy of Ophthalmology medical director of health policy, praised the addition of ASC procedures, as well as the CMS decision to raise the conversion rate in tandem with the consumer price index for urban consumers.
“Having payments linked long term to hospital [outpatient department] payments is huge because hospitals always get an update each year, and new technology is priced into payments long term,” Dr. Rich said in an e-mail interview. “After many years of public comments and advocacy efforts, the AAO is pleased with the adoption of an exclusive list. In the past, CMS had laborious criteria for ASC coverage. Now CMS says that unless there is undue risk to the patient, the procedure can be done in the ASC. That is the good news.”
However, he expressed a few reservations about the CMS proposed and final rulings.
“Before if you wanted to do a chalazion on a child, the ASC would not get paid,” Dr. Rich said. “Now you can do it at the ASC, but the payment is no more than the practice expenses paid for the procedure in the office — about $25. That is the bad news.”
Starting in 2010, the ASC conversion factor will rise in tandem with the consumer price index for urban consumers, according to a statement issued by the American Society of Cataract and Refractive Surgery.
“I think that a system in which there’s a linkage to the hospital rates provides some level of fairness and, importantly, some level of stability for the industry,” Mr. Romansky said.
However, the proposed 65% ASC conversion factor falls short of the desired 75%, which ophthalmology advocates have lobbied for, Mr. Romansky said.
“I’m disappointed that CMS ignored our recommendations regarding the conversion rate,” he said.
Some gains, some losses
Of the top 15 ASC volume codes, cataract will increase the most in the next 4 years, Dr. Rich said.
“The 4-year transition will lessen the pain of the cuts to YAG, the only ASC ophthalmic payment to fall,” Dr. Rich said.
Payments for retinal procedures will increase an average 108%, “which will make retina docs welcome citizens in the ASC,” he noted.
Glaucoma-filtering fees will rise, but the costs of filtering devices and patch grafts are “bundled” into the ASC payment. Surgeons performing filters with drainage devices may have to avoid ASCs until the filtering fee rises in 3 years and covers the cost of the devices, Dr. Rich said.
CMS was expected to accept comment on the proposed rule until Sept. 14.
For more information:
- William L. Rich III, MD, FACS, can be reached at American Academy of Ophthalmology, Government Affairs Division, 1101 Vermont Ave. NW, Suite 700, Washington, DC 20005-3570; 202-737-6662; fax: 202-737-7061; e-mail: hyasxa@aol.com.
- Michael A. Romansky, JD, can be reached at 1201 Pennsylvania Ave. NW, Fifth Floor, Washington, DC 20004; 269-469-0999; e-mail: mromansky@verizon.net.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.