ASCA Advocates for Changes to CMS 2025 Proposed Payment Rule

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ASCA Advocates for Changes to CMS 2025 Proposed Payment Rule

Comments include proposals to continue aligning update factors, additions to the ASC-CPL and changes to the ASCQR Program

BY KARA NEWBURY | SEPTEMBER 13, 2024

Earlier this week, ASCA submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD).

Use of the Hospital Market Basket to Update ASC Rates

If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.6 percent. This update is a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction of 0.4 percentage points mandated by the Affordable Care Act.

ASCA has long proposed that CMS align the ASC update factor with the one used to update HOPD payments and was successful in getting a five-year trial for calendar years (CY) 2019–2023. Due to the impact of the COVID-19 pandemic on volume for part of that period, CMS extended the trial an additional two years, through 2025. In its comments, ASCA commended CMS for continuing to use the hospital market basket to update ASC payments, better aligning ASCs with HOPDs. ASCA requested that CMS continue to update ASCs using the hospital market basket indefinitely. ASCA also provided examples of ASC costs that are far outpacing this small, positive update, such as staffing, supplies and anesthesia, and encouraged CMS to continue to explore ways to better account for these rising costs. ASCA’s 2025 advocacy efforts will be focused on advocating for continued use of the hospital market basket to update ASC payments.

Additions to the ASC Covered Procedures List

CMS proposed to add 20 medical and dental surgical procedures to the ASC Covered Procedures List (ASC-CPL) for CY 2025. CMS proposed the following four medical codes: 0717T, 0718T, 0795T and 0801T; and the following 16 dental codes: D7251, D7280, D7410, D7411, D7412, D7413, D7414, D7415, D7450, D7451, D7460, D7461, D7485, D7521, D7530 and D7540. ASCA did not request that these codes be added.

CMS did not propose to add any of the codes ASCA submitted in response to the ASC-CPL Pre-Proposed Rule Recommendation Request back in March. The recommendation request process is a new way to submit codes for consideration that CMS rolled out this year. ASCA submitted both cardiovascular and spine codes for consideration. In this proposed rule, CMS did not even mention that the procedures had been submitted for consideration.

In its comments, ASCA focused on the cardiac ablation and spine codes from its March submission.

Regarding the cardiac ablation codes—93613, 93619, 93620, 93623, 93650, 93653, 93654, 93655, 93656 and 93657—ASCA cited a large, multicenter safety and feasibility study electrophysiologists recently conducted that included more than 4,000 cardiac electrophysiology procedures performed across six ASCs during the COVID-19 pandemic under the CMS Hospitals Without Walls program. Findings from the study demonstrated that catheter ablations performed in ASCs and HOPDs both had very low rates of acute complications, even lower than other comparable cardiac procedures already included in the ASC-CPL (i.e., pacemakers/ICD implants and elective PCI procedures). Catheter ablation procedures performed in the ASC setting demonstrated lower rates of urgent hospital admissions than at HOPDs and very low rates of 30-day admissions.

For the spine codes, Posterior Lumbar Interbody Fusion (22630) and Combined Posterior Lumbar and Posterior Lumbar Interbody Fusion (22633), ASCA cited a study published in the International Journal of Spine Surgery. Legacy Surgery Center in Little Rock, Arkansas, enrolled as a temporary hospital through the Hospitals Without Walls program in May of 2020 during the COVID-19 public health emergency (PHE) and was able to compile objective medical safety and outcome data from lumbar interbody fusions in the Medicare age group. Patients were 65 and older with a mean age of 73 years. The facility’s surgeons published data on their Medicare patients during the PHE, confirming this same advantage in Medicare-aged patients undergoing lumbar interbody fusion surgery in the ASC setting.

In its comments, ASCA also criticized CMS’ lack of transparency for not publishing the list of codes submitted through the ASC-CPL Pre-Proposed Rule Recommendation Request process.

Changes to the ASC Quality Reporting Program

CMS proposed to adopt the three measures below for the ASC Quality Reporting (ASCQR) Program. The agency refers to these as “cross-program proposals,” as it also proposed to add these measures to the Hospital Outpatient Quality Reporting and Rural Emergency Hospital Quality Reporting Programs.

  1. The Facility Commitment to Health Equity (FCHE) measure, proposed for adoption beginning with the CY 2025 reporting period/CY 2027 payment determination, assesses a “facility’s commitment to health equity by using equity-focused organizational domains aimed at advancing health equity for all patients.” Facilities must attest to five different domains, including: Equity is a Strategic Priority, Data Collection, Data Analysis, Quality Improvement and Leadership Engagement.
  2. The Screening for Social Drivers of Health (SDOH) measure, proposed for adoption beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination, includes screening for health-related social needs (HRSN) of patients across five domains: food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety.
  3. The Screen Positive Rate for Social Drivers of Health (SDOH) measure, slated to begin with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination. indicates the rate of patients who “screened positive” for the five social drivers of health found in the screening measure.

ASCA opposed these new measures in its comments, as none of them have been tested in the ASC setting and ASCA does not believe ASCs are the appropriate setting for collection of much of this information. In addition, it is unreasonable to expect facilities to report data in 2025, the same year that the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey becomes mandatory.

In addition to the cross-program proposals, CMS has requested public comment on the “potential development of frameworks for specialty focused reporting and minimum case number for required reporting under the ASCQR Program.”

ASCA welcomes the opportunity to work with the ASC Quality Collaboration and CMS to determine whether specialty-specific frameworks are feasible or appropriate for the ASC setting. ASCA has concerns that CMS might simply try to take measures that are currently reported by physicians in the Quality Payment Program and add them to the ASCQR Program. ASCA, like CMS, supports coordination of care between sites of services but worries about duplication of efforts if identical quality measures are included in both programs.

CMS did not propose any changes to the OAS CAHPS Survey, a patient experience survey, which becomes a mandatory component of the ASCQR Program on January 1, 2025. ASCA continues to recommend changes, such as an electronic-only option, to reduce the cost burden on facilities.

Unfortunately, CMS also kept ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel in the ASCQR Program without modification. In its comments, ASCA reiterated its opposition to this burdensome measure and requested that, at the very least, CMS move to annual reporting for this measure rather than one week per month as is currently required.

ASCA also raised concerns with ASC-21: Risk-Standardized Patient Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the ASC Setting (THA/TKA PRO-PM), finalized in 2024 rulemaking, with voluntary reporting slated to begin with the CY 2025 and 2026 reporting periods followed by mandatory reporting beginning with the CY 2027 reporting period. This measure includes preoperative data collected from 0 to 90 days before the procedure and postoperative data collected between 300 and 425 days after the procedure.

A THA/TKA PRO-PM was only recently mandated for inpatient hospitals that have been working toward implementation for years. ASCA implored CMS to test this proposed measure in the ASC setting before implementation. ASCA also raised concerns that although voluntary, expecting reporting from any ASCs in 2025 is unreasonable and does not consider the burden of beginning mandatory reporting for the OAS CAHPS Survey in the same year. In addition, CMS has no education available for surgery centers that will be required to submit data, instead directing these facilities to webinars specifically for inpatient hospitals. Given the extensive preparatory work needed for the THA/TKA PRO-PM and the lack of any guidance from CMS, voluntary reporting in 2025 is not reasonable and should be delayed.

The final rule is typically released around Halloween and is statutorily required to be released by November 2, which is 60 days prior to its January 1, 2025, effective date. ASCA will provide final rule resources upon its release.