Becker's Spine Review

18 SPINE SURGEONS CMS paying for total knees in ASCs, boosts ASC payment rate 2.6% in 2020: 4 details By Angie Stewart C MS included a site-neutral payment policy and added total knee arthro- plasty to the ASC-payable list in its 2020 Medicare Hospital Outpatient Pro- spective Payment System and ASC Payment System Final Rule, released Nov. 1. Four things to know: 1. Total knee arthroplasty are now eligible for Medicare payment in the ASC setting. Knee mosaicplasty, six coronary intervention pro- cedures, and 12 procedures with new CPT codes were added to the ASC-payable list. 2. CMS will continue using the hospital mar- ket basket update for ASC payment rates through 2023. Payment rates for ASCs that meet relevant quality reporting requirements will increase 2.6 percent under the hospital market basket calculation. e update will "promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the low- er-cost ASC setting," CMS said. 3. CMS' ASC quality reporting program re- quires ASCs to meet quality reporting re- quirements to avoid a 2 percent fee schedule reduction. CMS didn't remove any measures in the final rule, but it is adding one claims- based measure: ASC-19: facility-level 7-day hospital visits aer general surgery proce- dures performed at the ASC. 4. e final rule includes a site-neutral pay- ment policy that eliminates payment differ- ences between hospital outpatient settings and physician office settings to reduce "un- necessary utilization in outpatient services." CMS is completing a two-year phase-in that is designed to lower copayments for benefi- ciaries and save Medicare an estimated $800 million in 2020. "We are grateful that this proposed rule contin- ues the sound policy of updating ASC Medi- care payments for inflation on par with hospi- tal outpatient departments," said ASCA CEO Bill Prentice. "In addition, proposing to add total knee arthroplasty to our procedures list so soon aer moving it from the inpatient-on- ly list, as well as a number of cardiac codes, speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting." n CMS expands CRNA privileges under 2020 fee schedule: 2 updates By Angie Stewart C MS finalized changes to the Medicare Physi- cian Fee Schedule that expanded payments to certified registered nurse anesthetists in 2020. 1. The final rule includes a provision that allows CRNAs to "to perform the anesthetic risk and evalu- ation on the patient they are anesthetizing" in ASCs. 2. Changes to CMS' documentation policy will al- low CRNAs and other advanced practice registered nurses to review and verify notes in a patient's med- ical record instead of re-documenting them. "A study published by Nursing Economics in May/ June 2010 found that CRNAs acting as the sole an- esthesia provider are the most cost-effective model for anesthesia delivery, and there is no measureable [sic] difference in the quality of care between CRNAs and other anesthesia providers or by anesthesia de- livery model," CMS said in its final rule. "We believe this alignment provides for continuity of care for the patient and allows the patient's anesthesia profes- sional to have familiarity with the patient's health characteristics and medical history." n 2020 price transparency rules for OPPS finalized By Rachel Popa CMS finalized a price transparency policy in its 2020 outpatient prospective payment system. The policies would apply to all hospitals in the U.S., requiring them to publicly post standard charge information starting in January 2021. The CMS policy applies to at least 300 "shoppable" services that can be scheduled by a consumer — 70 of the charges were se- lected by CMS, and 230 were selected by hospitals. CMS said the requirements are intended to give patients the ability to compare payer-specific negotiated charges across healthcare settings. The policy requires hospitals to display the information on a web- site, accessible without charge. The information must include a description of the service, the payer-specific charges, negotiat- ed cash prices and minimum and maximum negotiated charges. The information must be updated annually, with the date of the update clearly stated. CMS also issued a proposed rule that would require employ- er-based group health plans and insurers offering group and individual coverage to share prices and cost-sharing information with patients. If finalized, the rule would make negotiated rates for in-network providers and allowed amounts for out-of-net- work providers public on a website. n

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