This month’s ASCA Report includes information on ASCA resources to support ASC quality reporting, updates on recommended changes to the covered procedure list (CPL), a correction on previously reported clinician reimbursement rates and update on federal price Transparency legislation. A special thank you to ASCA from WISCA for all of their leadership and support of ASCs through the year, and for sharing these valuable updates.
Federal Regulatory Update
ASCA’s ASC Quality Reporting Program Resources Updated for 2024: ASCA has updated our ASC Quality Reporting (ASCQR) Program home page to reflect 2024 measures and deadlines. You can also visit ASCA's updated ASCQR Program requirements webpage for information on how to comply with ASCQR Program requirements in 2024, and the Ambulatory Surgical Center Quality Reporting Specifications Manual for more information on all measures. Facilities should also be sure to check out the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey page which provides more information on the OAS CAHPS survey which will become a mandatory component of the ASCQR Program in 2025. If you have specific procedures you would like ASCA to advocate for, please contact Kara Newbury.
Pre-Proposed Rule CPL Recommendation Process: The Centers for Medicare & Medicaid Services (CMS) has provided more information regarding the new recommendation process for the ASC Covered Procedures List (ASC-CPL). This process enables interested parties to submit codes for consideration to be added to Medicare's ASC-CPL. The submission period will start on January 1, 2024, and conclude on March 1, 2024, for 2025 rulemaking. ASCA will continue to advocate for the addition of complexity-adjusted code combinations and alignment with the Hospital Market Basket to update reimbursement rates. More information about the recommendation process will be available in January in ASC Focus Magazine’s Digital Debut. If you have specific procedures you would like ASCA to advocate for, please contact Kara Newbury.
Clinician Reimbursement Correction Notice: Medicare reimbursement for clinicians is set to decline by 3.37 percent unless Congress acts. Several major specialties that operate in ASCs, such as orthopedic surgery, ophthalmology and vascular surgery, are expected to see negative impacts. ASCA has been active in advocating for relief from these cuts, most recently signing on to a letter with 53 other health organizations requesting congressional action. Representatives Mariannette Miller-Meeks (R-IA), Ami Bera (D-CA), Larry Bucshon (R-IN), and Kim Schrier (D-WA) circulated a “Dear Colleague” letter to members of the US House urging quick legislative action to prevent the 3.37 percent reimbursement cut scheduled for January 1, 2024. In previous years, a correction notice has been issued to resolve this issue. ASCA expects the Centers for Medicare and Medicaid Services (CMS) will release additional information in the next few weeks. In addition, CMS did not release the drug and biological rates with the final rule release. Therefore, ASCA expects information to be included in the January update.
Update on Federal Price Transparency Legislation.
On December 11, the Lower Costs, More Transparency Act (H.R. 5378) passed the US House of Representatives by a vote of 320–71. As previously reported, language pertaining to ASCs under Sec. 104 of H.R. 5378 is identical to the price transparency legislation that ASCA lobbied against in July. On Thursday, December 14, the companion bill, S. 3548, was introduced in the US Senate. Section 5 (5)(B)(i-ii) of the legislation nearly matches the language of H.R. 5378. ASCA has been working closely with committee staff to improve the legislation and will report on any updates. If passed, implementation would begin in January 2026. Pertinent takeaways from Sec. 104 (Ambulatory Surgical Center Price Transparency):
More information is available in ASCA’s Digital Debut. Contact David Opong-Wadee at dopongwadee@ascassociation.org with any questions.
WISCA will host monthly legislative updates open to all members starting in 2024. Updates will be held the first Thursday of each month at 12pm. Updates will be presented by the WISCA lobby team and provide an opportunity for Q&A and discussion on topics of interest to ASC leaders across the state. Sign up today for the next legislative update (register).
WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:
· Medicare Physician Fee Schedule
On November 2, CMS released the Medicare Physician Fee Schedule (MFPS) final rule. The rule finalizes a 2024 conversion factor of $32.74, a roughly 3.4 percent reduction from 2023. Notably, CMS finalized the implementation of a new g-code, G2211, beginning on January 1, 2024. This code was first proposed in the 2020 rulemaking cycle but has been delayed due to the Consolidated Appropriations Act of 2021. The code is contentious because it triggers a significant budget neutrality adjustment that is the main factor in the overall negative conversion factor reduction. CMS estimates that G2211 is driving 90 percent of the negative 2.2 percent budget neutrality adjustment. ASCA opposed its implementation in comments responding to the CY 2024 MPFS proposed rule. There will likely be a significant lobbying push from the physician community to oppose the implementation of the code before the end of the year. On November 6, ASCA was one of 54 health organizations that signed-on to a letter (see below) to Congressional leadership opposing the implementation of G2211:
o On behalf of the 54 organizations representing physicians and other health care providers across the United States, we write to urge Congress to stop the 3.4% cut in Medicare physician payment that the Centers for Medicare & Medicaid Services (CMS) recently finalized in the Calendar Year 2024 Medicare Physician Fee Schedule (PFS) final rule. The agency acknowledges in the final rule that, due to budget neutrality requirements, the majority of the cut is created by the decision to increase payments for primary care services through the creation of the new G2211 code.
We acknowledge policymakers’ desire for additional investments in primary care, however these increases are being paid for by an across-the-board cut to all clinicians. It is imperative that Medicare patients have access to the full range of essential health care services, including primary and specialty care. Further, clinicians are facing these cuts when they are expecting a 4.6% increase in medical practice cost inflation in 2024, as measured by the Medicare economic index.
Therefore, in the absence of long-term reform, Congress must stop the full 3.4% cut.
· General Update on 2025 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has provided more information regarding the new recommendation process for the ASC Covered Procedures List (ASC-CPL). This process enables interested parties to submit codes for consideration to be added to Medicare's ASC-CPL. The submission period will start on January 1, 2024, and conclude on March 1, 2024, for 2025 rulemaking. ASCA will continue to advocate for the addition of complexity-adjusted code combinations and alignment with the Hospital Market Basket to update reimbursement rates. If you have specific procedures you would like ASCA to advocate for, please contact Kara Newbury.
A bill that would require ASC’s to visually record a surgery at the patient’s request has been circulated but not yet introduced. The bill’s authors reference surgeries in Wisconsin that resulted in fatalities as the foundation for why patients need this type of protection. WISCA, in conjunction with the WI State Medical Society and the Wisconsin Hospital Association has opposed this legislation in the past and will continue to do so this session.
The APRN bill establishes an Advance Practice Registered Nurse credential in Wisconsin. WISCA has been closely monitoring AB 154/SB 145, as one of the biggest sticking points within that new credential relates to pain management procedures and the collaborative agreements surrounding nurse anesthetists. There has been an amendment requiring CRNA’s have a collaborative agreement with a physician who has a pain management background. WISCA has pushed back against this amendment arguing that it would hurt our ability to provide services, especially in more rural areas, where there are fewer physicians with a pain management background. The bill has passed the Senate without this amendment and is being considered in the Assembly. In addition to our concerns, it appears the Governor still has certain issues with the bill. and it is unclear how and if it will move forward.
All legislators are watching the current redistricting case before the Court as it could change the boundaries and even the timelines of their next race for office. As oral arguments begin the question is what happens if the Court does deem the maps unconstitutional. No one knows for sure, but it is expected that there will be a mad dash to get new maps in place before the 2024 elections. There are certainly hurdles to this, and while it is expected that the court will side with the plaintiffs challenging the maps, there are still more questions than answers at this point to how it will impact the legislative battleground moving forward.
The legislature has finished work for the year having tackled several contentious issues in the final days of session. Bills of interest included a plan to help the Milwaukee Brewers pay for maintenance on Am Fam Field in a deal designed to keep the Brewers in Milwaukee until at least 2050. While the bill sailed through the State Assembly it ran into resistance in the State Senate. There was bi-partisan support and opposition as some legislators believed it necessary for the state to help facilitate a deal to keep the Brewers from leaving while others argued that the taxpayers shouldn’t be on the hook for the upkeep on a stadium owned by the team. The Senate passed the bill 19-14 with eleven republicans voting for it and eleven voting against. The Governor promptly signed the legislation.
Another bill that came to a head on the final session day of 2023 was an alcohol enforcement bill that had become contentious over the issue of “wedding barns”. While the Assembly passed the bill by a 90-4 vote in June, the Senate as of November had not had a hearing on the bill. The bill clarifies several issues related to alcohol sales, distribution and taxation, most of which were supported by the Wisconsin Department of Revenue. However, one provision would change how Wisconsin’s growing wedding barn industry must classify themselves to serve alcohol, and the industry adamantly objected to the change. Some legislators support their position, which stalled the bill. However, through a procedural play, Senate leadership brought the bill to the floor and it passed 21-11. The bill was signed into law by Governor Evers.
On November 2, CMS released the Medicare Physician Fee Schedule (MFPS) final rule. The rule finalizes a 2024 conversion factor of $32.74, a roughly 3.4 percent reduction from 2023. Notably, CMS finalized the implementation of a new g-code, G2211, beginning on January 1, 2024. This code was first proposed in the 2020 rulemaking cycle but has been delayed due to the Consolidated Appropriations Act of 2021. The code is contentious because it triggers a significant budget neutrality adjustment that is the main factor in the overall negative conversion factor reduction. CMS estimates that G2211 is driving 90 percent of the negative 2.2 percent budget neutrality adjustment. There will likely be a significant lobbying push from the physician community to oppose the implementation of the code before the end of the year. On November 6, ASCA was one of 54 health organizations that signed on to a letter (attached) to Congressional leadership opposing the implementation of G2211. ASCA also opposed implementation in comments responding to the CY 2024 MPFS proposed rule.
On Thursday, November 2, the Centers for Medicare & Medicaid Services (CMS) released its 2024 final payment rule for ASCs and hospital outpatient departments (HOPD). Of note, CMS added multiple procedures to the ASC Covered Procedures List (ASC-CPL) that were not included in the proposed rule, including total shoulder arthroplasty, total ankle, and thyroid surgery. CMS increased the complexity and cost of total shoulder and ankle procedures by one APC group compared to total knee and hip procedures.
CMS finalized its proposal to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025. ASCA advocated for this extension. The extension of this policy results in an effective update of 3.1 percent for ASCs—a combination of a 3.3 percent inflation update based on the hospital market basket and a productivity reduction of 0.2 percentage points mandated by the Affordable Care Act. This is an increase of 0.3 percent from the proposed rule. Please note that this is an average, and updates might vary significantly by code and specialty.
Other initial observations about the 1,672-page final rule follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally under this final rule.
1. 21194 (Reconst lwr jaw w/graft) 2. 21195 (Reconst lwr jaw w/o fixation) 3. 23470 (Reconstruct shoulder joint) 4. 23472 (Reconstruct shoulder joint) 5. 27006 (Incision of hip tendons) 6. 27702 (Reconstruct ankle joint) 7. 29868 (Meniscal trnspl knee w/scpe) 8. 33289 (Tcat impl wrls p-art prs snr) 9. 37192 (Redo endovas vena cava filtr) 10. 60260 (Repeat thyroid surgery) 11. C9734 (U/s trtmt, not leiomyomata)
ASCA staff will continue to analyze the final rule in detail and will provide more information to help ASC operators understand its impact on their centers soon.
The next data submission deadline for ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel is Wednesday, November 15, and covers the data collected in the second quarter of 2023, April 1 through June 30.
For ASC-20, facilities must select one week per month on which to report to meet the quarterly submission requirement. Please note that this Ambulatory Surgical Center Quality Reporting (ASCQR) Program measure is completely separate from the withdrawal of the federal vaccination requirement for healthcare personnel that the Centers for Medicare & Medicaid Services (CMS) announced in May. Your facility must continue to report on ASC-20 until CMS removes it from the ASCQR Program, or you will be subject to future Medicare payment penalties. As a reminder, CMS has proposed to keep this measure in the ASCQR Program for 2024. ASCA will continue to advocate for the removal of this measure.
The ASCQR Program provides a Web-Based Measure Status Listing that allows facilities to check their data submission status for web-based measures in the program. Enter your ASC’s NPI or CCN in the ASC Facility and CCN Lookup section to see your facility’s submission status. ASCs that fail to meet ASCQR Program requirements are subject to a 2 percent cut to their fee-for-service (FFS) Medicare reimbursements.
If you have questions, contact the ASCQR Program Support Contractor at 866.800.8756 or through the Quality Question and Answer Tool.
Association of Wisconsin Surgery Centers 563 Carter Court, Suite B Kimberly WI 54136 920-560-5627 I WISCA@badgerbay.co
