Value-Based Payment Rules May Be Bound for ASCs

Centers that perform cataract, endoscopy, colonoscopy, and laser eye surgery could soon be paid on the basis of quality measures under a plan unveiled by the U.S. Department of Health and Human Services.

Medicare beneficiaries are increasingly receiving services at ambulatory surgical centers, whose numbers are growing by nearly 4% a year, to 5,175 in 2008. That year, these centers administered 5.6 million procedures to 3.3 million beneficiaries, the agency said in a recent report to Congress. ASCs received $3.1 billion from Medicare that year, nearly 10% higher than what they were paid in 2007.

Nevertheless, Medicare "does not require ambulatory surgical centers (ASCs) to collect, report, and validate cost and quality data to determine resource consumption and associated clinical outcomes," the agency said. That is about to change sometime in fiscal year 2012.

A value-based purchasing program for ASCs, similar to those outlined for inpatient and outpatient hospital care, is on the way, the agency said. "CMS intends to propose in CY 2012 rulemaking implementing an ASC quality measure reporting program under section 109(b) of the

Medicare Improvements and Extension Act of 2006," it said.

New VBP rules for ASCs based on performance, however, require several steps. Among these, the HHS Secretary needs statutory authority from Congress to establish a VBP program and allow for performance-based payments. At present, the law "permits the Secretary to implement a quality reporting system for ASCs in a manner so as to provide for a reduction in any annual update for failure to report on quality measures. However, the authority limits the Secretary to reducing the annual update for failure to report – not based on performance." 

Second, new quality measures are needed to expand the set now available.