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Board of ASC’s awards CASC Achievement – October 2008
MEDICARE PROPOSED 2009 ASC PAYMENTS
July 14, 2008
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that will, when final, govern ASC reimbursements in 2009. The rule has a comment period which ends September 2nd, 2008. The attached document “How to Comment on the 2009 Medicare Payment Rule” gives CMS’s instructions for submitting comments to the rule.
Summary
The proposed rule contains no major methodology changes from the current rule. Payments for most procedures will change slightly because of the Relative Weight adjustment that CMS performs each year. The expected transition to the new APC payment system continues. Overall, eight of 11 specialties tracked by the ASC Association will see an increase in payments while three have decreases. Ophthalmology and GI will continue to trend down with codes like 66984 dropping approximately 2% and 45380 dropping 6%.
Contrary to what CMS had previously discussed, the proposed rule does not require the implementation of any quality reporting measures. These are still expected in the future, however it is apparent that CMS is not prepared to move forward with ASC reporting in 2009.
Resources
The ASC Association has provided numerous resources on their website to help ASCs review the impact of the 2009 payment. We encourage you to review the proposed rule and payments and to contact GSASC and the ASC Association about changes that you would like to see. GSASC will be part of an industry-wide effort to submit comments on the proposed rule to CMS.
- The CMS Proposed Rule- A copy of the rule from Medicare that includes the 2009 proposed ASC payments is available on the ASC Associations website here: www.ascassociation.org/09proposedpaymentrule.pdf
- Rate Calculator – Calculate your proposed local payment rates. This calculator allows you to insert your proposed ASC wage index for 2009 and see the national payment rates, local payment rates, amount Medicare pays and the beneficiary copayment amounts for each procedures proposed to be payable effective January 1, 2009. www.ascassociation.org/calc09p.xls
- List of Payable Procedures – This document contains the proposed list of payable procedures effective January 1, 2009, and corresponding national payment rate. www.ascassociation.org/list09p.pdf
- Proposed ASC List Additions – This file Includes information about the 6 procedures proposed to be added in 2009 – CPT code, a short description and national payment rate. www.ascassociation.org/add09p.pdf
- Device Intensive Procedures – This chart lists the procedures proposed to be device intensive in 2009 and the proposed 2009 ASC payment rate. The chart also includes whether or not they are proposed to be device intensive for the first time. www.ascassociation.org/intensive09p.pdf
- Ancillary Services – This chart includes the list of proposed covered ancillary services integral to covered surgical procedures for 2009 including ancillary services for which payment is packaged. A short description of the service and the proposed payment rate is also included. www.ascassociation.org/ancillary09p.xls
- Office Based Procedures – This chart lists the procedures proposed to be classified as office based in 2009, the proposed 2009 payments and whether the rates are based on the hospital outpatient department weights or on the physician’s practice expense portion. www.ascassociation.org/office09p.pdf
To view the Department of Health and Human Services Medicare ASC Rule, click here.
Georgia General Assembly Legislative Update – April 2008
Governor Perdue releases reorganization plan for DHR
NPI Required March 1
March 3, 2008
As a reminder, starting March 1, 2008, ASCs will be required to provide their National Provider Identifier (NPI) or an NPI/legacy pair in the primary provider field of all CMS-1500 forms submitted to Medicare. Claims without the NPI in this field will be rejected.
This means that today, February 29, 2008, is the last day providers can use only legacy numbers, such as the UPIN, in the primary provider field. After today, providers may use both the NPI and a legacy number, but only if the carrier can find the legacy number on the Medicare NPI crosswalk. Providers may continue to provide legacy numbers for the referring practitioners for claims received by carriers by May 23, 2008. After May 23, 2008, any claims that contain a legacy number anywhere will be rejected unless they satisfy a very limited number of rarely applicable exceptions.
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Hospital spending expected to double by 2017: CMS
February 26, 2008 - 8:25 am EDT
Hospital spending will double to more than $1.3 trillion by 2017, making up roughly 30% of all healthcare spending and representing the largest portion, by far, of any provider group, according to the CMS.
Hospital spending is expected to have grown at a rate of 7.5% to $696.7 billion in 2007, an increase of 0.4 percentage points from the rate in the previous year, when spending was $648.2 billion.
More broadly, national health spending is expected to have grown 6.7% last year, reaching $2.2 trillion overall, and is expected to hold steady at that rate over the next 10 years, CMS actuaries told reporters. Still, healthcare spending will account for 20% of GDP by 2017 if left unchecked.
Andrea Sisko, an economist in the National Health Statistics Group, said that a loosening of Medicaid payment restrictions drove the spike in hospital spending, but that overall, the sector is expected to see slower growth in the later years.
While national spending should be stable over the next decade, Medicare outlays are expected to quicken as more baby boomers become eligible. -- by Matthew DoBias
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Healthcare
management news
Thursday, December 14, 2007
Challenge likely for surgery exception to CON rules
Health board changes rules; lawsuit expected
By Diane Wagner, Rome News-Tribune Staff Writer
More general surgeons will be able to offer procedures such as breast biopsies and hernia repairs in their own clinics instead of hospitals, following a rule change approved Thursday by the state Board of Community Health.
The change, effective in January, reclassifies general surgery as a single specialty. That means surgeons will no longer need a Certificate of Need from the state before opening a small clinic.
“It’s going to make health care more available and more affordable,” said state Rep. Barry Loudermilk, R-Cassville. “I co-sponsored legislation that would have done the same thing, but it didn’t make it to the floor for a vote.”
But the administrative move is expected to spark a legal challenge from opponents who contend only the Georgia General Assembly can create exemptions to the CON law.
Dan Sweitzer of Floyd Medical Center said the Georgia Hospital Association is concerned a proliferation of surgery centers will draw paying patients from hospitals that also must treat charity cases.
The Board included a resolution calling on the Georgia General Assembly to require exempt clinics to “participate in the total community burden” by also treating Medicaid and indigent medical patients.
But GHA spokesman Kevin Bloye dismissed the resolution as “ineffective lip-service” and said the rule change by a board charged with ensuring health care access is “ironic and unfortunate.”
Bloye said modifications are needed to the state’s CON law, but the Board is usurping the authority of the Legislature.
“I think it’s safe to assume there will eventually be a lawsuit, although there are still a lot of details to work out,” he said.
The House Health and Human Services Committee validated that argument in a called meeting Wednesday. State Rep. Katie Dempsey, R-Rome, joined the attendees in a unanimous vote objecting to the Board action. Click here to see a video of the meeting of the House Health and Human Services Committee.
But its Senate counterpart did not weigh in to kill the rule change, and Loudermilk, who also sits on the House HHS Committee, said not all its members are opposed.
“We didn’t have a lot of notice about the meeting, and I’m not the only one who couldn’t make it,” he said. “I’m very strong on legislative oversight, but you can get to a point where you’re legislating so much you can’t get anything done.”
Supporters of the rule change include Rome radiologist Dr. Dan Hanks. A longtime member of the Georgia Board for Physician Workforce, Hanks testified at a Nov. 28 public hearing that CON law restrictions contribute to the state’s shortage of surgeons.
“This is a real big win for patients and general surgeons, and we expect the Board of Community Health to prevail,” said Kathy Browning, director of the Georgia Society of General Surgeons.
Click here to see the CON Commission final report and recommendations.
Andrew T King MHA CASC
2024 Winsted Way
Marietta, GA 30062
770-998-9571 Office & Fax
404-314-8088 cell
Acumen-Healthcare.com
DCH exempts surgeons from CON rules
Thursday, December 13, 2007 - 3:25 PM EST
Atlanta Business Chronicle - by Urvaksh Karkaria Staff Writer
The Department of Community Health board on Thursday OK'd a change that could make it easier to build surgeon-owned outpatient surgery centers.
The move is likely to trigger legal counter assaults by hospital systems and legislative blow back.
The board, in an expected move, voted to classify general surgeons as a single specialty and exempt them from the time consuming Certificate of Need rules. That rule change takes effect in January.
Hospitals oppose the change, arguing that physician-owned surgery centers siphon off their best-paying patients, leaving the burden of the uninsured for hospitals to bear. Supporters of the rule change say it will attract badly needed general surgeons to the state and gives patients access to high quality general surgery at a lower cost.
Critics of the move say the DCH does not have the legal authority to make the rule change.
"The legislature has laid a very strong case to the fact that they are the only ones who have statutory authority in dealing with this," said Jimmy Lewis, a lobbyist for 56 Georgia hospitals. "[On Dec. 11 the House Health and Human Services Committee convened] for the sole purpose of telling DCH 'you're about to make a bad decision.'"
The legislature has the capacity to override DCH's decision. Willis referred to the showdown between the legislature and DCH as "two 800-pound gorillas going after each other."
The board today also voted and approved a resolution asking the General Assembly to create legislation requiring exempted owners and operators of ambulatory surgery centers that provide charitable care to document and report their usage data to the state.
Exempting general surgeon-owned ambulatory surgery centers from the CON process is a good thing for patients because it would allow general surgeons' patients to have the same access to ambulatory surgery care as patients of other surgical specialties like orthopedics, said Kathy Browning, executive director of the Georgia Society of General Surgeons.
Ambulatory surgery centers, in general, offer more personalized care, and at about a third of the cost, compared with hospitals.
The rule change will also attract more general surgeons to Georgia, according to Browning.
"We are 30 percent below the national average for general surgeons per capita in our state," she said.
Being exempt from CON approval could shave years off the time it takes to open a new outpatient surgery center, Lewis said.
"As fast as a group of general surgeons can amass the investment capital, and get the plans drawn, and get it built," he said.
That's how quickly they can get into it."
Under the old rules, general surgeons looking to build an ambulatory surgery center would have to make a detailed case to regulators showing need for the service, and then fight an expensive legal battle from medical providers looking to keep the project from happening.
"That literally could take two to five years," Lewis said. "[Once exempted, that process] could take less than one year."
A ballooning of ambulatory surgery centers geared toward commercially insured patients, could also whack hospital bottom line. Unlike ambulatory surgery centers, hospitals must provide care to people who walk into their ERs, regardless of the patient's ability to pay.
A cutback in Medicaid funding by the state, Lewis said, has left hospitals with three main sources of revenue -- surgery services, imaging services and patients with commercial insurance.
"The state is now snatching away one of the three legs of a three-legged stool that's held hospitals together," Lewis said.
While the decision to exempt ambulatory surgery centers from the CON process won't necessarily shut hospitals down, it could cause them to cut services.
Losing ambulatory surgery business to ambulatory surgery centers can "cause hospitals much financial pain in very short order," Lewis said.
Andrew T King MHA CASC
2024 Winsted Way
Marietta, GA 30062
770-998-9571 Office & Fax
404-314-8088 cell
Acumen-Healthcare.com
AMNews:
Sept. 10, 2007. States review nonprofit hospitals' tax
exemptions ... American Medical News
Clyde Reese to be named executive director
of the Division of Health Planning
Clyde Reese, a widely respected lawyer and health planning
expert when he served as general counsel for the Department
of Community Health (DCH) several years ago, has returned
to DCH as executive director of the Division of Health
Planning.
Reese, who replaces
Rob Rozier in the health planning position, will be responsible
for “administration
and oversight of the Georgia CON [certificate of need]
program, including legal and health planning issues,” DCH
spokesperson Amanda Seals said.
Reese was deeply involved
in CON issues when he was general counsel for DCH under
former commissioners Russ Toal, Gary Redding and Tim
Burgess. He left the department nearly four years ago
to go into private practice as a specialist in healthcare
regulatory law. He’s been back with
the agency since Sept. 19.
In other personnel
changes at DCH, which administers Medicaid, PeachCare,
and the State Health Benefits Plan insurance programs,
Charemon Grant has stepped down as legal counsel for
the department.
Commissioner Rhonda Medows has not named a replacement
yet.
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