November 3, 2023
Following release of the Centers for Medicare & Medicaid Services’ (CMS) 2024 final payment rule for ASCs and hospital outpatient departments (HOPD), the Ambulatory Surgery Center Association (ASCA) commended CMS for adding total shoulder surgery, total ankle surgery and a total of 37 surgical procedures to its ASC Covered Procedures List beginning January 1, 2024.
“Adding these new codes to the list of procedures that ASCs can provide to Medicare beneficiaries,” said ASCA Chief Executive Officer Bill Prentice, “benefits both Medicare patients, who now have a lower-cost choice for obtaining the care they need, and the Medicare program itself, which will save millions of dollars as volume moves to the high-quality surgery center site of service.”
Citing excellent outcomes data for total shoulder surgeries performed in surgery centers throughout the US over many years, ASCA has long encouraged CMS to allow ASCs to perform these procedures for Medicare beneficiaries. Since Medicare policies also influence the policies other insurers put in place, ASCA expects the benefits of this decision to reach beyond the Medicare population and improve access to care and cost savings for patients covered by a broad range of insurers.
CMS’ 2024 final payment rule also includes several other policies aligned with requests ASCA made to the agency over time. They include
- extended use of the hospital market basket, the same measure that HOPDs use, to set the inflationary update for ASCs;
- a decision not to finalize a proposal to readopt quality measure ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures, a measure ASCA raised concerns about in its comment letter on the proposed rule;
- delay of mandatory reporting for a new total hip and total knee quality measure, ASC-21; and
- retaining ASC 11: Cataracts Visual Function as a voluntary quality reporting measure.