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A U G U S T 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
Kara Newbury
CODING & BILLING
Mixed Reviews for 2015 ASC Payment Rule
Payment disparities persist, but ASCs could gain ground in other areas.
M
edicare's proposed 2015 payment rule for ASCs contains a
mix of good and bad news for surgery center owners and
managers. On the plus side, the ASC payment proposal
accommodates some important requests made by the ambulatory sur-
gery center community, including the addition of 10 new spine proce-
dures to the ASC list of payable procedures and more favorable terms
for device-intensive procedures. On the negative side, the disparity in
payments between hospital outpatient departments (HOPDs) and
ASCs continues to grow under the proposal. Here's a rundown of the
important points you need to know.
Payment update.
CMS is proposing an effective payment
update of 1.2% for ASCs and an effective payment update of
2.1% for HOPDs. The disparity is due in large part to the dif-
ferent update factors used for each site of service. Facility fees for
HOPDs are updated annually, based on the hospital market basket,
which measures the inflation of medical costs such as equipment, sup-
plies and staffing. ASC facility fees, on the other hand, are updated
based on the Consumer Price Index for all Urban Consumers (CPI-U),
which measures the cost of consumer goods such as bread, milk and
gasoline. The CPI-U is unrelated to changes in medical costs and is
historically lower than the hospital market basket.
The result is that under the proposal, the rates paid to ASCs and
HOPDs will continue the troubling trend of diverging in 2015. To see
how wide the gap has grown, one need only go back about a decade.
In 2003, Medicare paid hospitals only 16% more, on average, than it
paid ASCs. Today, HOPDs receive 81% more than ASCs for the same
services. If this proposal is finalized, in 2015, HOPDs would be paid
