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    CMS proposes cuts to urology procedures performed in ASCs

    More codes approved for outpatient surgery; reimbursements to shrink

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    Bob Gatty
    Washington—On Aug. 8, 2006, the Centers for Medicare & Medicaid Services released a proposal to reform the Medicare ambulatory surgical center payment system beginning Jan. 1, 2008, and the news for urology appears to be mixed.

    The proposal includes two changes that will be implemented in 2007. They include an update of the current ASC list and, as required by the 2005 Deficit Reduction Act (DRA), a cap on payments to ASCs at the hospital outpatient department payment rate.

    While no urology codes have been proposed for addition to the list in 2007, an AUA memo to members advises that 13 urology codes are affected by the DRA payment cap. They range from a 7% cut for CPT code 52001 (cystourethroscopy with irrigation and evacuation of multiple obstructing clots) to an 80% cut for CPT code 51785 (needle electromyography studies of anal or urethral sphincter, any technique). A complete list of all urology codes affected by the DRA payment cap is available at the web site of FASA Inc., the membership and advocacy arm of the Foundation for Ambulatory Surgery in America, http://www.fasa.org/.


    Fast Facts
    CMS is proposing to use for ASCs the same payment groups used under the outpatient prospective payment system (OPPS) and to pay ASCs at 62% of the OPPS payment, phased in over 2 years. CMS also is proposing to modify the criteria for determining whether Medicare will reimburse an ASC for a particular procedure.

    If there is good news, it would be that all surgical procedures other than those that pose a significant safety risk or generally require an overnight stay could be performed in ASCs. For procedures added to the list of procedures that are commonly performed in a physician's office, CMS proposes to cap the ASC payment rate at the physician office payment rate.

    "The AUA is in the process of analyzing the proposed reforms and their effect on urology ASCs, and will provide additional information as well as a chance for our members to weigh in as soon as possible," the AUA memo said.

    "The major reforms we are proposing in payments for ambulatory surgical centers will provide for more appropriate payment for the broad range of services that ASCs can provide," explained CMS Administrator Mark B. McClellan, MD, PhD. "Our goal is to help our beneficiaries get the outpatient care they need in the most appropriate setting by eliminating payment differences that inappropriately favor one outpatient setting over another and that may add to Medicare costs."

    CMS is acting in response to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires that the revised payment system be designed to pay more accurately for ASC services and to have aggregate expenditures in 2008 that will be the same as they would have been under the current system.

    "The proposed revisions more closely align payments in the ASC and OPPS to encourage the most efficient and appropriate choices of outpatient settings for ambulatory surgical procedures," CMS said in a press release.

    The proposed changes brought immediate challenges from two organizations representing ASCs.

    "The American Association of Ambulatory Surgery Centers' [AAASC] core membership are physician-owned, single-specialty ambulatory surgery centers," noted Craig Jeffries, AAASC executive director. "We are delighted with the policy direction that CMS is taking that will expand opportunity for urologists to more fully participate in the benefits of ASC ownership."

    However, Jeffries went on to say that the AAASC is "not satisfied with the CMS details in their recent proposal, and we will work diligently with our physician ASC leaders to have CMS's final rule fully realize the value of ASCs as a choice for Medicare beneficiaries and as an efficient work environment for surgeons."

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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