Freeze, reduction in ASC payments proposed

WASHINGTON — Congress has been advised to freeze ambulatory service center payments in 2004 and to equalize ASC and hospital outpatient payment rates.

According to press releases from two ophthalmic organizations, the Medicare Payment Advisory Council (MedPAC) held meetings on the topic before making these recommendations earlier this month.

MedPAC, an independent commission that advises Congress on Medicare payment issues, originally recommended that, until a new ASC payment system is implemented, ASCs be paid the lower of the ASC or hospital outpatient facility fee. In ophthalmology, the procedure most notably affected by this recommendation would be YAG posterior capsulotomy. CPT code 66821 (after-cataract laser surgery) has a hospital payment of $224; the ASC payment for the same procedure is $446. Under the new recommendations, the ASC reimbursement rate would be reduced to $224.

Due to lobbying efforts, however, MedPAC adopted a modified recommendation calling on the Centers for Medicare and Medicaid Services to first determine the extent to which the services provided in ASCs and hospital outpatient settings are comparable and what reimbursement rates should be, according to the Outpatient Ophthalmic Surgery Society (OOSS).

OOSS President Jerry Levy, MD, said his organization has been led to believe the Bush administration may include a recommendation in its 2004 budget proposal that ASC rates be reduced.

“Combined with recent actions by CMS to withhold anticipated updates to the list of approved ASC procedures, ophthalmic ASCs may be in for a difficult period,” he said.

The American Academy of Ophthalmology has raised concerns about patient access with CMS’ continued delay in updating the ASC payment system. Last week, the AAO and the Society for Excellence in Eyecare sent a critical letter to Congress, asserting that the “failure to provide an ASC update … frustrates the intent of the Congress to encourage the expansion of services that can safely and effectively be performed in ASCs.”

CMS published a proposed expanded ASC list in 1998 but never finalized the list. Early last year, CMS said it would update its list before the end of the year, but never did, according to the AAO.

“This delay is unacceptable,” said William Rich, MD, AAO secretary for federal affairs, in a press release. “Broadening the list of ophthalmology procedures performed in ASCs will lower costs to the Medicare program, beneficiaries, and is good medicine.”