Industry experts react to the CMS Final Rule for 2024 and the impact it will have on ASCs.
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2024 final payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPD), and it includes significant developments that will benefit patients and the ASC industry as a whole.
The most significant development was a surprise, with CMS adding 11 CPT codes to the ASC Covered Procedures List (ASC-CPL) that were not included in the proposed rule. Notably, these additions included two codes — CPT 23470 and 23472 — covering total shoulder replacements and one code — CPT 27702 — for total ankle replacement.
"CMS covering these new total joint codes for Medicare beneficiaries is terrific news," says Jessica Nelson, vice president of revenue cycle services for Surgical Information Systems (SIS). "ASCs have been safely performing total joint replacement procedures on commercial patients for many years and on Medicare patients for the past several years following CMS' approval of total knees and hips. Medicare beneficiaries can now receive this same high-quality care for their total shoulders and ankles, and ASCs with total joint programs can grow their patient volume and recruit surgeons specializing in these procedures."
The remaining eight codes unexpectedly added to the ASC-CPL included those covering hip tendon incision, meniscal knee replacement, and repeat thyroid surgery, while 26 dental codes in the proposed rule were finalized.
"These decisions by CMS tells me they're listening to physicians and patients about the patient experience and outcomes in ASCs as well as organizations like ASCA lobbying for appropriate expansion of the ASC-CPL," says Daren Smith, vice president of ASC solutions for SIS. "It's also likely that the agency is reviewing the growing quantity of ASC quality data and determining what those of us in the industry have been saying for a long time: Surgery centers are the appropriate site for most outpatient procedures."
Smith points to data submitted to the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, data gathered and published by organizations like the ASC Quality Collaboration and American Joint Replacement Registry, and data generated by surgery centers that participated in the Hospital Without Walls initiative as important information supporting the continued migration of surgical care into the outpatient surgical setting.
There were a few other noteworthy, positive developments. CMS finalized its proposal to continue aligning the ASC update factor with the one used to update HOPD payments through 2025. This policy was scheduled to conclude at the end of 2023. As a result of the extension, ASCs will receive a 3.1% Medicare payment boost for 2024 — an increase of 0.3% from the proposed rule.
CMS also decided to adopt just a single new measure for the ASCQR, ASC-21: "Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip and/or Total Knee Arthroplasty," with a three-year voluntary reporting period prior to the mandatory reporting that will begin with calendar year 2028. The agency chose not to finalize a proposal to readopt ASC-7: "ASC Facility Volume Data on Selected ASC Surgical Procedures."
"I believe these announcements further show that ASCs are doing an extraordinary job of delivering exceptional care," Smith says. "While CMS may not be adding significant new quality reporting requirements for ASCs, it remains essential that we continue to publish our impressive data. This is especially true for those procedures making their way into surgery centers, like total shoulders and ankles for Medicare patients. By proving with data that ASCs are providing great outcomes, we should continue to achieve expansion of the ASC-CPL and will hopefully see CMS once again consider eliminating the inpatient-only list."