GOOD, BAD AND UGLY OF HOPD AND ASC PROPOSED RULE WITH AN EXPECTED CUTS OF 6% UNLESS THE CONGRESS ACTS ON IT

THE GOOD, BAD AND THE UGLY

GOOD
For ASCs, the update is changed similar to the HOPDs.

BAD
Multiple procedures, which were covered in ASCs are eliminated and changed to the inpatient only list.

UGLY
An addition of 6% cuts, 2% stemming from sequester cuts of the Budget Control Act of 2011 and 4% statutory PAYGO sequester resulting from passage of the American Rescue Plan Act lasting 10 years, totaling 6%.

On July 19, 2021, the Centers for Medicare and Medicaid Services proposed Medicare Payment rates for hospital outpatient department and ambulatory surgical center services. The comment period ends on September 17, 2021.

The hospital outpatient payment department (HOPD) systems and ambulatory surgery center (ASC) systems are subject to:

  1. A 2% sequester cuts stemming from the Budget Control Act of 2011. Expiration of the current reprieve from the repeatedly extended cuts brings the reality to start from 2020. Congress originally scheduled this policy to sunset in 2021, but it will now continue into 2030.
  2. Imposition of a 4% statutory PAYGO sequester resulting from passage of the American Rescue Plan Act, which will last for 10 years.
  3. Should Congress fail to act, which will mark the first time that Congress has failed to waive statutory PAYGO and extension of 2% sequester from Budget Control Act of 2011, which has been pushed way beyond its due time:

AMBULATORY SURGERY CENTERS

Important to note that CMS has proposed to reverse policy changes from the previous administration that added a significant number of codes to the ASC covered procedures list and began the process of removing the inpatient only list; however, CMS did propose to continue to align the ASC update factor used to update HOPD payments.

If the proposed rule were to be finalized as drafted, ASC would see an average overall covered procedures, an effective update of 2.3% – a combination of 2.5% inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2% points. While these are averages, specific updates for procedures may vary significantly by code and speciality.

In addition, there is also a positive development that CMS proposes positive device-intensive procedure policy for ASCs which may be beneficial; however, we will not know until the final effects are seen.

The proposed rule is available at: https://public-inspection.federalregister.gov/2021-15496.pdf

Table 1 shows ASC proposed payment rates for 2022, without and with potential 6% cut. Click here to view table.

As shown in this Table, overall there are increases ranging from 3% to 9% for majority of the procedures, with some procedures seeing cuts in their reimbursement for interventional procedures. However, with 6% cut which is also shown in the Table, these can have devastating effect with a net result of cuts rather than benefits.

HOSPITAL OUTPATIENT DEPARTMENTS (HOPDS)

HOPD proposed rates are similar to ASC changes as shown in Table 2. Click here to view table.

CALL FOR ACTION

Currently, ASIPP and SIPMS are vigorously working with Congress to reverse the cut in the conversion factor and also sequester cuts and PAYGO cuts. We would like also to prevent any further PAYGO risks with passage of 2 new bills in the Congress. If these 2 new bills pass separately, there is a risk of 8% additional cuts. However, if they pass as one, there will be a maximum of 4% cuts. Consequently, it is essential to stop all of these, or eliminate PAYGO option for the cuts.

ASIPP is a not-for-profit professional organization founded in 1998 now comprising over 4,500 interventional pain physicians and other practitioners who are dedicated to ensuring safe, appropriate and equal access to essential pain management services for patients across the country suffering with chronic and acute pain. There are approximately 8,500 appropriately trained and qualified physicians practicing interventional pain management in the United States. ASIPP is comprised of 49 state societies of Interventional Pain Physicians, including Puerto Rico and the affiliated Texas Pain Society.

SIPMS is a not-for-profit professional organization founded in 2005, with membership involving surgical centers focusing on interventional pain management, dedicated to ensuring safe, appropriate, and equal access to essential pain management services for patients across the country suffering with chronic pain. There are approximately 500 surgery centers across the nation approved by Medicare providing or solely or an overwhelming majority of interventional pain management services.

If you have any comments to be added, or if you would like to write your own comments, please feel free to do so. You may contact: Laxmaiah Manchikanti, MD, Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS, at 270-554-8373 ext. 4101 or email at [email protected] and/or Amol Soin, MD, President, ASIPP and SIPMS, at 937-434-2226 or email at [email protected]