Becker's ASC Review

27 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine – Call (800) 417-2035 T he Centers for Medicare and Medicaid Services has released its fi- nal 2015 ASC payment rule, according to an Ambulatory Surgery Center Association report. Here are eight things to know about the final rule. 1. ASCs payment rates will rise 1.4 percent in 2015. The bump in payment is based on a 1.9 percent expected rate of inflation minus a 0.5 percent pro- ductivity adjustment, as required by the Patient Protection and Affordable Care Act. 2. The payment increase is 0.2 percent higher than the 1.2 percent update included in the Medicare proposed rule. The proposed increase was based on projected inflation of 1.7 percent minus the 0.5 percent adjustment. 3. In the 2015 final rule, CMS updated ASC device-intensive procedures as those in which the device cost accounts for more than 40 percent of the total procedure cost. Previously, CMS defined device-intensive procedures as those in which the device cost accounted for more than 50 percent of the total pro- cedure cost. At the 50 percent threshold, there were 163 procedures in an am- bulatory payment classification that were not performed in ASCs due to lack of adequate reimbursement, according to the report. Now at the 40 percent threshold, there are 48 codes that are still prohibitive due to device costs. 4. CMS also made ASC-11: Cataracts: Improvements in Patient's Visual Function within 90 Days Following Cataract Surgery a voluntary measure for the ASC Quality Reporting Program. 5. The final rule also finalized the proposed quality measure ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate After Outpatient Colonoscopy. 6. There were several spine and neck surgery codes finalized for 2015 as well, including: • Neck spine fusion • Lumbar spine fusion • Spine fusion extra segment • Neck spine disc surgery • Low back disc surgery • Laminotomy single level lumbar • Removal of spinal lamina • Decompress spinal cord 7. The final deadline, as mandated by the final rule, for ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel is May 15, 2015. The quality measure must be reported through the National Healthcare Safety Network. 8. CMS is still using the CPI_U to update ASC payments, even after their actuaries indicate this method is inappropriate, according to ASCA CEO Bill Prentice. "Using different update factors for ASCs and HOPDs widens the gap between HOPD payments and ASC payments, further incentivizing a disturbing trend of conversions of ASCs to HOPDs and increases costs to the Medicare program, its beneficiaries and taxpayers who support the pro- gram." n CMS to Increase ASC Pay 1.4% in 2015 — 8 things to know By Carrie Pallardy and Laura Dyrda A s many medical practices struggle to stay solvent, almost half of physicians report their incomes have plateaued over the last year, according to the Physicians Practice Annual Physician Compen- sation Survey. Physicians Practice surveyed 1,338 physicians, with about 30 percent in solo practices, about 40 percent in group practices (two to nine physicians) and the rest in group practices with more than 10 physicians. About 40 percent of respondents were practice owners, 44.8 percent were employed physicians of a hospital or health system-owned practice and the remaining physicians (about 15 percent) were employees of an independent practice. Highlights from the survey are shown below. 1. Forty-two percent of respondents reported their personal income was about the same as last year. About 16 percent said their income was down by more than 10 percent and 10.3 percent said it was up by more than 10 percent. 2. About 51 percent of respondents described their net incomes from their practice as either slightly or highly disappointing, and 35.5 percent described their net incomes as either excellent or pretty good. 3. Fifteen percent of respondents said patient satisfaction accounts for 11 per- cent or more of their annual compensation. About 30 percent of physicians said all of their compensation is tied to productivity, while 36 percent said pro- ductivity is not a factor of their pay. 4. Physicians said the most popular strategies their practices are taking to boost revenue are increasing the number of patients seen per day (33.3 percent of respondents), taking on work outside of the practice (29.2 per- cent) and adding ancillary services (23.2 percent). 5. About 35 percent of practice owners predicted their practice's financial viability over the next three years will be mixed, saying their practice isn't growing significantly, but 32.3 percent predicted their financial viability will be robust, describing their practices as thriving. Only 9.5 percent predicted their financial viability will be poor to the point of needing to close their practices' doors within the next three years. 6. About 77 percent of respondents said their practices accept Medicare and 65 percent accept Medicaid. About 74 percent accept patients who pur- chase insurance plans through health insurance exchanges. 7. Almost half (47.3 percent) of respondents reported the Patient Protec- tion and Affordable Care Act has not affected their practices, while 13.2 per- cent say they see more patients than ever. About 11 percent of respondents said it has been more difficult to get paid on time by patients since the imple- mentation of the PPACA. n Physician Pay Hits a Plateau: 7 Findings on Practice & Personal Income By Tamara Rosin

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