Becker's ASC Review

14 ASC MANAGEMENT CMS finalizes 2022 rules with 255 procedures removed from ASC- payable list By Alan Condon C MS on Nov. 2 finalized the Outpa- tient Prospective Payment System and ASC Payment System final rule for 2022. What you should know: 1. In 2022, CMS is updating ASC payment rates by 2 percent for centers that meet ap- plicable quality reporting requirements. e move follows a section of the 2019 OPPS/ ASC final rule that agreed to apply the hos- pital market basket update to ASC payment rates through 2023. 2. e agency is also updating outpatient payment rates for hospitals that meet certain quality reporting criteria by 2 percent. CMS said the update is based on the projected hospital market basket increase of 2.7 percent and reduced by 0.7 percent for the productivity adjustment. 3. Due to a number of COVID-19 public health-related factors, CMS said 2020 claims data are not the best approximation of ex- pected outpatient hospital services in 2022. Instead, CMS believes that 2019 data — the most recent year prior to the pandemic — are a better approximation of expected costs for rate-setting purposes in 2022. erefore, the agency is generally using 2019 claims data to set the 2022 Outpatient Prospective Payment System and ASC payment rates. 4. CMS is finalizing its proposal to halt the elimination of the inpatient-only list and re- turn the list of services removed from the list in 2021, excluding CPT codes 22630 (lumbar spine fusion), 23472 (reconstruct shoulder joint), 27702 (reconstruct ankle joint) and their corresponding anesthesia codes. "is change in policy promotes transpar- ency and ensures that any service removed from the IPO list has been reviewed against Medicare's long-standing IPO criteria to determine if it is appropriate for Medicare to pay for the provision of the service in the outpatient setting," the agency said. 5. In the 2021 OPPS/ASC final rule, CMS enacted a policy in which procedures removed from the IPO list beginning Jan. 1, 2021, would be indefinitely exempted from certain medical review activities related to its two-midnight rule, which states that inpatient admission and payment are appro- priate when the treating physician expects the patient to require a stay that crosses two midnights and admits the patient based on that expectation. is change was made to accommodate the number of procedures be- ing removed from the IPO list in 2021. But, as CMS is halting its elimination of the IPO list, the agency is finalizing a proposal to revise the exemption for procedures removed on or aer Jan. 1, 2021, from the IPO list to the exemption period that was previously in effect — a two-year period. 6. In 2022, CMS is reinstating its 2020 criteria for adding procedures to the ASC covered-procedures list. CMS requested comment on whether any of the 258 proce- dures proposed for removal from the cov- ered-procedures list met the 2020 criteria. It received 140 procedure recommendations, including new procedures and procedures that were already on the covered-procedures list and not proposed for removal. 7. Following a review of these recommen- dations, CMS is keeping six procedures — three that were already on the ASC covered-procedures list and three proposed for removal — and removing 255 of the 258 procedures proposed for removal. e three codes that were proposed for removal and are being retained are: • 0499T: Cystourethroscopy, with me- chanical dilation and urethral therapeu- tic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed • 54650: Orchiopexy, abdominal ap- proach, for intra-abdominal testis (e.g., Fowler-Stephens) • 60512: Parathyroid autotransplantation 8. Beginning in March 2022, a process will be adopted to allow an external party — par- ticularly specialty societies that are familiar with procedures in their specialty — to nom- inate a procedure to be added to the ASC covered-procedures list. If CMS determines that a procedure meets the requirements to be added to the list, it would propose to add the procedure to the list for Jan. 1, 2023. n How USPI is pulling ahead of competitors in the ASC industry By Alan Condon D allas-based Tenet Healthcare continues to ramp up its surgery center business after its subsid- iary United Surgical Partners International announced an agreement to acquire a stake in nine ASCs in North Carolina, Texas and Florida. Earlier this year, Tenet sold five Florida hospitals to Dallas-based Steward Health Care for $1.1 billion. Surgery centers, however, were not included in the trans- action, further pointing to Tenet's strategy of strengthening its outpatient footprint. The $1.1 billion sale will compensate for Tenet's acquisition of up to 45 ASCs from Towson, Md.-based SurgCenter Develop- ment — a deal that also cost $1.1 billion. Most of the 45 ASCs have been acquired, with the remainder set to change hands by the end of the year, as some facilities wait for regulatory approval, accord- ing to the company. USPI will operate the musculoskeletal ASCs, which are in Florida, Arizona, Indiana, Louisiana, Maryland, Ohio, New Hampshire, Texas and Wisconsin. The 2021 acquisitions make USPI the largest musculoskeletal platform in the country, operating more than 330 ASCs, including 24 surgical hospitals, in more than 30 states. Tenet's recent deals have further ce- mented itself as the largest ASC manage- ment company in the country, further pulling away from Nashville, Tenn.-based AmSurg and Deerfield, Ill.-based Surgical Care Affiliates, its closest two competitors in the space. The company also has more than 11,000 affiliated physicians, another area that it continues to expand. In the first half of 2021, USPI said that it added more than 1,100 physicians to its medical staff. In the second quarter, the company introduced 25 new service lines across its network, primarily focused on spine and total joints — two key opportu- nities for growth in the ambulatory space — and is expected to see continued growth in these specialties through the end of this year and into 2022. n

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