Digital Debut

ASCA Advocacy Drives Success in 2023

The association thanks its members for their role in recent wins

BY KARA NEWBURY | DECEMBER 2023

2023 was a busy year for healthcare policies and ASCs were no exception. While ASCA has its work cut out for it in 2024, let’s take a minute to celebrate our successes from the past year.

Regulatory Wins

Additions to the ASC Covered Procedures List

The Centers for Medicare & Medicaid Services' (CMS) 2024 final payment rule for ASCs and hospital outpatient departments (HOPD) included several wins for ASCA and ASCs. Key among them is the addition of multiple procedures to the ASC Covered Procedures List (ASC-CPL) that were not included in the proposed rule, including total shoulder arthroplasty (TSA).

ASCA advocated tirelessly to add TSA to the ASC-CPL for the past three years. Most recently, on October 12, ASCA met with Doug Jacobs, MD, chief transformation officer at CMS, to raise concerns with the 2024 proposed payment rule. In the meeting, David Weinstein, MD, ASCA Board member and orthopedic surgeon with the Surgical Center of the Rockies in Colorado Springs, Colorado, discussed TSA (CPT 23472). He questioned why his colleagues performing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were allowed to do so on the Medicare population, but he was not allowed to perform TSA on the same population. Weinstein referenced research showing stellar outcomes of TSA performed in the outpatient setting, supported by his own experiences performing TSA in the ASC setting. ASCA has shared this research data with CMS.

In the rule, CMS also finalized the addition of 37 surgical procedures to the ASC-CPL, including the 26 dental codes that were included in the proposed rule. The agency finalized the addition of the following 11 surgical codes (short descriptor in parentheses):

21194 (Reconst lwr jaw w/graft)
21195 (Reconst lwr jaw w/o fixation)
23470 (Reconstruct shoulder joint)
23472 (Reconstruct shoulder joint)
27006 (Incision of hip tendons)
27702 (Reconstruct ankle joint)
29868 (Meniscal trnspl knee w/scpe)
33289 (Tcat impl wrls p-art prs snr)
37192 (Redo endovas vena cava filtr)
60260 (Repeat thyroid surgery)
C9734 (U/s trtmt, not leiomyomata)

Other than TSA, ASCA also highlighted total ankle replacement (CPT 27702) in its comment letter on the proposed rule, citing research indicating these procedures are safely performed on an outpatient basis. In addition, CPTs 33289, 23470 and 37192 were on the list of procedures that ASCA requested for addition to the ASC-CPL.

Update Factor Extension

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 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. However, this is an average and updates might vary significantly by code and specialty.

ASC Quality Reporting Program

CMS did not finalize its proposal to readopt ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures. ASCA raised concerns with this measure in its comment letter.

Legislative and Grassroots Wins

Congressmen Brad Wenstrup, DPM (R-OH), and John Larson (D-CT) reintroduced the bipartisan, bicameral Outpatient Surgery Quality and Access Act of 2023 in the US House of Representatives (H.R. 972) and Senators Richard Blumenthal (D-CT) and Bill Cassidy, MD (R-LA), introduced the legislation in the US Senate (S. 312) back in February. ASCA endorsed the legislation.

ASCA members advocated enthusiastically for their industry for National Advocacy Day. From February 27–March 1, 70 ASCA members traveled to Washington, DC, to participate in the first National Advocacy Day event in three years. Participants represented 31 states and met with 102 offices in both chambers of Congress to discuss the importance of and urge support for our legislation. In addition to the fly-in, 22 ASCs hosted members of Congress and their staff at their facilities. We have 10 new supporters of our legislation so far this session, several of whom signed on after meeting with their constituents.

Cost Reporting Provision

While ASCA likes to stay on the offensive, staving off threats to its members is just as critical—if not more so—than promoting its legislation. In May, the US House Committee on Energy & Commerce held a markup of legislation being considered in the committee. Markups are meetings that allow the committee to debate and consider amendments to measures under consideration. During the markup, Representative Jan Schakowsky (D-IL) filed an amendment that would have required ASCs to report cost data to CMS. ASCA staff and lobbyists convinced Schakowsky and her staff to withdraw the amendment.

ASCA also met with her staff to explain that ASC cost reporting is not beneficial to CMS because ASC reimbursement rates are directly tied to, and based off of, HOPD rates. In addition, costs differ among ASCs depending on the size and specialty, with certain specialties requiring expensive equipment to perform procedures while others are more dependent on their staff. Therefore, cost data would be of limited value to CMS when trying to determine reimbursement rates. ASCA will be on high alert for cost reporting language that might resurface in 2024.

Site-Neutral Legislation

The term “site-neutral” describes a payment policy in which reimbursement is the same for a certain service no matter where the service is provided. Congress has taken increased interest in site-neutral payment policies, but ASCA has thus far successfully staved off legislation that would drop certain ASC reimbursement rates to the physician’s office rates.

Since April 2023, various groups within Congress have discussed different pieces of draft legislation that use site-neutral policies as a mechanism for Medicare spending. On April 26, the US House Energy & Commerce Health Subcommittee held a five-and-a-half-hour hearing to discuss legislative solutions aimed at lowering healthcare costs, including discussion on site-neutral payments. ASCA submitted formal comments to the committee that expressed concerns about some of the draft legislation proposals and added additional context to issues within Medicare’s ASC payment system.

ASCA has consistently opposed policies that reduce payments to Medicare providers. Most current site-neutral policy proposals would bring hospital reimbursement down rather than increase ASC payments to be closer to HOPD rates. We support exploring site-neutral payment policies that will save the program money while maintaining or expanding access to care and will continue to work with policymakers to take a more thoughtful approach to any site-neutral policy discussions.

In Conclusion

ASCA’s accomplishments would not be possible without its members. The procedures that ASCA requested to add to the ASC-CPL came from feedback from its facility members. When a request to add a procedure has outcomes data attached, it has the highest chance of being added to the ASC-CPL. ASCA is grateful for all the supporting information it received from its members this year to expand the ASC-CPL. We look forward to hitting the ground running in 2024.