Becker's ASC Review

59 CODING & BILLING Staying ahead of value-based care in 2018 — Cardinal Health's Marilyn Denegre-Rumbin tells you how By Eric Oliver A s the U.S. enters the next stage of healthcare reform, ASCs are strategically positioned to capitalize on the transition toward value-based care and the low-cost healthcare movement. In a Feb. 22 webinar hosted by Becker's Healthcare and sponsored by Cardinal Health, Cardinal Health's Director of Payer and Reimburse- ment Strategy Marilyn Denegre-Rumbin shared four major trends af- fecting the ASC reimbursement space in 2018: increased acquisition activity and competition from hospitals and hospital outpatient de- partments, regulatory changes, evolving technological and consumer demands, and private payers seeking alternative payment models. Hospital impact Surgery is shiing toward the outpatient space, and health systems have a growing interest in acquiring, partnering with or establishing their own ASCs to continue capturing surgical revenue. From 2006 to 2013, inpatient Medicare surgical volume decreased 17 percent, while outpatient volume increased 33 percent, according to data from Regent Surgical Health. Concerning individual specialties, the largest shis from inpatient to outpatient have been with cardiac and vascular services. From 2006 to 2013, inpatient cases decreased 13 percent and 9 percent, respec- tively, while outpatient cases increased 12 percent and 18 percent, respectively. Orthopedics and neurosurgery continue to increase in both the inpatient and outpatient settings, with the majority of growth seen in the outpatient space, according to data from Regent Surgical Health. As healthcare continues to transition from fee-for-payment to value- based care, ASCs will be key players. at being said, the surgery center space poses a challenging reimbursement dilemma. Because payers reimburse hospitals at a higher rate than they do surgery centers, case volume is essential to drive surgical center growth and financial security. ere are two ways ASCs can capitalize on the outpatient shi: 1. By partnering with independent surgeons or surgeons that split time between hospitals and ASCs to increase case volume 2. By offering ownership stakes to surgeons looking to partner with a health system or to develop their own center Reimbursement Ms. Denegre-Rumbin said ASCs are positioned to capitalize on outpatient growth because of changes in the payment reimburse- ment landscape. e Outpatient Prospective Payment System final rule for 2018, the Medicare Access and CHIP Reauthorization Act of 2015, and the Merit-based Incentive Payment System have all made their mark on the surgery center landscape and will continue to do so in 2018. CMS laid the groundwork for the shi to value-based care through MACRA and MIPS. Although the policies only affect Medicare payments, commercial payers are strongly incentivized to follow in CMS' footsteps. The OPPS final rule will reimburse ASCs at a 1.2 percent adjusted consumer price index rate in 2018. CMS estimates making $4.6 billion in total payments to ASCs in 2018, an increase of $130 million year over year. Ms. Denegre-Rumbin referred to the pro- jection as "promising." "Value-based payments transform traditional business models by putting significant revenue and risk at stake," Ms. Denegre-Rumbin said. "Building the outcomes-based financial models and data infra- structure to maximize value-based care reimbursement pathways will be fundamental to sustainable growth in the future." Besides increasing outpatient surgery rates, the 2018 Quality Pay- ment Program proposed final rule made a series of changes. e rule: • Offers virtual group participation • Increases the low-volume threshold to $90,000 in allowed Medicare Part B charges, or 200 patients • Allows the use of the 2014 edition of Certified EHR Technology • Adds bonus scoring points for caring for complex patients or exclusively using the 2015 edition of CEHRT • Includes MIPS performance in quality scoring • Includes an option to use facility-based scoring for facility- based physicians • Creates flexibility for small practices through exemptions and bonus points • Keeps MIPs scoring at its 2017 weights • Removes total knee arthroplasty from the inpatient-only list • CMS also created new opportunities for ASCs by reversing mandatory bundles for hip and knee, cardiology and oncology procedures. Changing demands in the ASC space & private payers Patients are driving change in the healthcare space as they're maxi- mizing their purchasing power and creating a consumer-driven system. ASCs need to implement technology to drive consumers to their center over the competition. On healthcare consumerism, Ms. Denegre-Rumbin said, "It's about supplying the information and decision support tools [patients] need, along with financial incentives, rewards and other benefits that encourage personal involvement in altering health and healthcare purchasing behaviors." Consumer access to the internet through computers and mobile Patients are driving change in the healthcare space.

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