Staying informed about federal healthcare updates is crucial for providers, especially when it comes to reimbursement changes. On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would raise Ambulatory Surgical Center (ASC) payments by 2.6% under the 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System.
The proposal is currently in its 60-day public comment period, with the final rule expected in November 2024. Here’s a breakdown of what this means for providers.
Overview of the Proposed ASC and Hospital Outpatient Changes
The proposed 2.6% payment increase for ASCs stems from a projected 3% market basket update, minus a 0.4% productivity adjustment, in line with Medicare’s inflation metrics.
For hospital outpatient departments (HOPDs) meeting quality reporting requirements, the updated payment system would continue to support intensive outpatient program (IOP) payment structures:
- Two classifications: one for three services/dayand another for four or more services/day
- 2023 claims dataand current cost reports will inform 2025 rate-setting
- Payment updates are also proposed for partial hospitalization programs (PHPs)delivered in HOPDs
ASC Quality Reporting Program: New Proposals
To further refine quality tracking in ASCs, CMS is proposing the following:
- Health Equity Commitment Measure
CMS aims to introduce a Facility Commitment to Health Equity metric, focusing on voluntary reporting around social determinants of health (SDOH).
- Updated Reporting Criteria
ASCs may be asked to submit data based on quality measures that are:
- Broadly relevant to most ASCQR participants
- Linked to common conditions and procedures
- Accessible via claims or abstracted data
CMS is actively seeking public feedback on this update.
- Change to Removal Policy
CMS plans to replace the immediate measure removal policy with an immediate measure suspension policy, allowing more flexibility when retiring metrics.
Notable Hospital Outpatient Reporting Changes
One major update to hospital outpatient quality reporting (OQR) includes:
- Removal of the lumbar spine MRI measurefor patients with low back pain, following findings that improvement on this metric did not correlate with better outcomes.
Concerns from the Ambulatory Surgery Center Association (ASCA)
The ASCA has voiced frustration over CMS’s decision not to include 18 requested cardiac and spine procedures in the updated Covered Procedures List (CPL).
According to ASCA’s CEO, including these procedures would expand care access for Medicare beneficiaries and align payment policy with real-world clinical experience.
The association is calling for a more transparent, surgeon-informed process in future rulemaking.
Supporting Orthopedic and Radiology Providers Through Change
Regulatory updates like these can be complex—but they don’t have to be overwhelming. At Healthcare Information Services (HIS), we bring decades of experience helping orthopedic and radiology practices navigate billing, coding, and payment updates with confidence.
If you need expert support to ensure your ASC remains compliant and profitable under CMS’s evolving policies, we’re here to help.
