Becker's ASC Review

14 ASC MANAGEMENT Vermont surgery center appeals state limitations to state Supreme Court — 6 insights By Eric Oliver A my Cooper, CEO and co-owner of Colchester, Vt.-based Green Moun- tain Surgery Center, is appealing a decision by the state's health board to limit the multispecialty ASC to five specialties, the Burlington Free Press reported. What you should know: 1. e Green Mountain Care Board de- cided in June to limit the center to the five specialties listed in its certificate-of-need application from 2015, unless the care board approves a new offering. e center is ap- proved to offer five specialties and is allowed to perform plastic surgery and eye surgeries, except for stand-alone cataract procedures. 2. e case stems from the care board's decision to prevent the surgery center from performing cataract surgery, which Green Mountain sought to do. e board did not allow the center to perform stand-alone cataract surgeries, but did allow the center to perform cataract surgeries in conjunction with retina surgeries. 3. e limitation seems to have been imposed in response to a series of objec- tions. Juli Larson, MD, founder and medical director of South Burlington, Vt.-based e Eye Center, the state's other surgery center, objected to allowing Green Mountain to perform cataract procedures. She argued that the duplicated offering would affect her center financially and could cause her cur- rent patients to seek care elsewhere. 4. e Eye Center's other four owners sent letters to the board distancing themselves from Dr. Larson and her position. ey said e Eye Center took no position on the case. 5. Ms. Cooper argued the board was being used to "carve up monopolies for some people," and that the board's decision undermined the surgery center's viability. Ms. Cooper said the five specialties in her initial CON filing were based on the center's minority owners, and that she intended to allow the surgery center to serve any board- certified physician in the state. 6. When the board made its decision in June, it anticipated there would be strong demand from Green Mountain to add specialties, but that the certificate-of-need approval did not act as an all-encompassing approval. In its ruling, the board wrote: "Finally, while the board acknowledged the potential for future demand from surgeons in other spe- cialties, it clearly intended to limit the types of procedures that could be done at [Green Mountain]. It expressly declared that it was imposing conditions in the [certificate of need] 'that limit the expansion of services.'" n ASC pay increase for 2021 eliminated in MedPAC's draft proposal: 4 things to know By Rachel Popa M edPAC, a committee that advises Congress on how to adjust Medicare payment rates, drafted proposals to adjust 2021 payment rates for ASCs, hospitals and physicians Dec. 5, according to Bloomberg Law. Four things to know: 1. MedPAC will vote on eliminating a 2.8 percent pay- ment increase for ASCs in 2021, as well as a proposal for a flat physician payment update in January. Bloomberg reported there was strong agreement among commis- sioners about the MedPAC payment recommendations, leading to an expedited vote. 2. The report also stated the commission is in agree- ment about requiring ASCs to provide CMS with annual cost reports to better evaluate centers' profit margins and revenue to assess payments. According to Bloom- berg, MedPAC believes ASCs are already adequately compensated. 3. MedPAC will also vote on a recommendation adjusting the 2021 payment update to hospitals from 2.6 percent to 2 percent. The commission's preliminary recommenda- tion includes a bonus payment model that would increase hospital payment rates by 3.3 percent in 2021, rewarding cost efficiency and value. 4. The commission recommended that physicians par- ticipating in an alternative payment model receive a 5 percent pay increase in 2021 for care that's high quality and low cost. "The MedPAC Commission's refusal to recognize the value of access to ASCs for Medicare beneficiaries and the taxpayers who fund the Medicare program is re- flected in their absurd position on ASC payments," said William Prentice, CEO of the Ambulatory Surgery Center Association, in a statement to Becker's ASC Review. "We have repeatedly asked for an opportunity to meet with the commissioners to discuss how the ASC model can reduce Medicare costs, but those requests have fallen on deaf ears. Fortunately, the leadership at CMS has a better understanding of our value and has consistently ignored these misguided recommendations." n

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