On July 1, 2009, CMS posted the proposed update to the Hospital Outpatient and Ambulatory Surgery Center Payment Systems for 2010. As usual, the proposal represents a mixed bag for ambulatory surgery centers (ASCs). On the positive side, CMS is proposing to add 28 procedures to the list of covered services, 26 of which are currently among those excluded from the ASC list because they were previously perceived to be too sophisticated for the ASC, and therefore not safe or requiring overnight stay if performed in ASCs. These additions reflect a willingness to re-examine procedures previously deemed too complicated for the ASC, and to view ASC capabilities more expansively. At the same time, CMS is proposing to newly designate six procedures as office-based for CY 2010, and to make permanent the office-based designations of four surgical procedures that currently have temporary office-based designations. These 10 procedures will be paid the lesser of the ASC payment amount or the non-facility practice expense amount paid under the Medicare Physician Fee Schedule.
In other welcome news, CMS is proposing to increase ASC payments for inflation for the first time in more than six years. However, because the Medicare law specifies that ASC payments are to be inflated by the Consumer Price Index, whereas payments to hospitals are to be inflated by a separate inflator called the Market Basket Index, CMS is proposing to increase ASC payments by only 0.6 percent, while hospital payments will be updated by 2.1 percent. As a result, the proposed CY 2010 ASC conversion factor is $41.625, while the proposed hospital conversion factor for CY 2010 is $67.439. Once other adjustments are factored in, ASC procedures not subject to the transition would be paid 58.7 percent of corresponding OPPS procedures in 2010, down from the 61 percent relationship currently in effect.
Comments on the proposed rule are due August 31, 2009.