Fees for ASCs need to be updated

Several organizations have begun lobbying for revisiting payment and regulation of ASC services.

Issue: September 1, 2005

ByMichael A. Romansky, JD

A note from the editor:


	Alan E. Reider, Editor

For nearly 3 years, Ocular Surgery News has published OSN Compliance Case Studies under my editorship. We are evolving the subject of compliance into a new column, which will address topics including legislation, malpractice and coding. These are issues ophthalmologists face in their practices each day.

We hope future columns will guide you to make wise decisions in your practice. This first installment, by Michael A. Romansky, JD, OSN Regulatory/Legislative Affairs Section Member, discusses proposed legislation for changes in reimbursement for ASCs.

If you have future topics you would like us to address, please forward them to my attention at osn@slackinc.com.

Alan E. Reider, JD
OSN Regulatory/Legislative Affairs Section Editor

When I began my service as a lawyer and lobbyist for the Outpatient Ophthalmic Surgery Society in 1983, the ASC landscape bore little resemblance to the one we know today. At that time, there were approximately 100 ASCs in the country. Today, Medicare has certified more than 4,000 facilities, of which an estimated 700 specialize primarily in ophthalmic surgery. In 1983, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) had just published the inaugural payment rates for ASCs; the facility fee for cataract was $336. In 2005, ASCs are reimbursed about $970 for the procedure.

Does this represent progress? In a sense, it does. However, CMS regulates ASCs under the same regulation it published nearly 2 decades ago. ASC facility fees have not been rebased since 1989. Facilities are reimbursed only for procedures that have been specifically designated on the ASC Procedure List as appropriate for performance in the surgery center setting. The result is that dozens of ophthalmic procedures that are reimbursed when furnished in a hospital or a physician’s office are not compensated when the procedures are performed in an ASC. In addition, payment rates have been updated to account for inflation on only a sporadic basis.

Although there might have been legitimate concerns about the safety and efficacy of surgery centers when the Medicare ASC program was established 23 years ago, no elected official or federal agency staffer can question that an ASC offers surgical care to Medicare beneficiaries that is comparable in quality to and usually costs less than the services offered in the hospital outpatient department. However, we are inundated by well-intentioned but obsolete regulations that in their current form deny high-quality, lower-cost care to the country’s aging population.

OOSS plans to address many of our concerns about payment for and regulation of ASC services through legislation to amend the law that created the ASC benefit. OOSS, in coordination with other ASC trade associations, the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology, other surgical specialty organizations and the medical devices industry, is hoping to secure passage in 2005 of legislation that will promote our ability in the era ahead to continue to offer the highest-quality and most cost-effective care to Medicare beneficiaries.

Goals

The ASC community is currently in the process of drafting this legislation. We hope to accomplish the following.

The ASC procedures list should be eliminated. The decision as to the appropriate site of surgery (office, ASC or hospital) should be made by the surgeon in consultation with the patient.
CMS should meet its statutory mandate to develop a new ASC payment system by 2008. The new ASC payment system should link ASC facility fees to the payments made to hospital outpatient departments for the same surgical procedures.
ASCs should receive the same annual updates paid to hospitals and enjoy other additional payments made to hospitals, including drugs, implants and medical devices.

Compliance and the Law [logo] The introduction of legislation to promote the ASC industry is just the first step toward reform. We are actively soliciting representatives and senators to sponsor this legislation and to be advocates on our behalf as this bill moves through Congress. We will call on ophthalmologists who own or operate within ASCs to contact legislators. We will also challenge the ophthalmic ASC community to financially support the election campaigns of federal legislators who are allied with our interests by contributing to OOSPAC, our organization’s political action committee.

It is time for the ASC industry to be heard on Capitol Hill and for federal policy makers to modify the current ASC regulatory and payment system to promote the performance of surgery in the ASC environment.

For Your Information:

Michael A. Romansky, JD, represents the Outpatient Ophthalmic Surgery Society and the American Association of Ambulatory Surgery Centers before Congress and federal agencies and serves as counsel to ASCs and physicians throughout the country. He can be reached at 1201 Pennsylvania Ave. N.W., Fifth Floor, Washington, DC 20004; 202-626-6270; fax: 202-626-6272.