Reimbursement rates changing for 2023, ASCA fights for more approved procedures

Posted Feb 16, 2023 under:

Reimbursement Changes Coming in 2023

Physicians are working to better understand changes coming to reimbursements later this year.

Reimbursement Changes 2023

VMG Health breaks down upcoming changes. ASCA fights for further additions.

As we move forward into 2023, ambulatory surgery centers (ASCs) are looking forward to another year of growth. With the new year also comes changes made by the Centers for Medicaid and Medicare (CMS). These changes include revisions to reimbursement rates and additions to the ASC CPL.

Report Breakdown

VMG Health authors Jack Hawkins, Ryan Mendez, and Colin Park, CPA/ABV, ASA summarized the latest updates in their report, ASCs in 2022: A Year in Review. The report reviews industry performance in 2022 and looks ahead to updates for 2023.

When looking back on 2022, VMG Health notes several continued changes among the ASC subindustry. These changes include an ongoing shift away from hospital outpatient departments into ASCs for low-risk patients and high-acuity cases. The shift has shown to save money for patients and payors alike, while offering high-quality care in safe environments. The article notes that orthopedic procedures lead the way in making the move in site of care.

When discussing reimbursement changes, the report notes that updates to the ASC payment system will be made, “using the hospital market basket update instead of the Consumer Price Index for All Urban Consumers (CPI-U).”

CMS finalized changes for calendar year 2023 (CY 2023) on Nov. 1, 2022, bringing overall expected growth and leading to a 3.8% increase in payments this year.

“This increase is determined based on a projected inflation rate of 4.1% less the MFP reduction of 0.3% mandated by the ACA,” the article states. “The 3.8% growth in payments represents the largest increase in projected payments year over year and is a direct result of the increase in labor, supplies, and other cost pressures seen over the last year.” 

The payment increases in 2023 is nearly double the rates of the previous eight years according to the report. The previous largest increase occurred in 2020 when payments increased by 2.6% since 2015.

These continued pressures, along with growing international changes and issues impacting cost pricing and resources will play an ever-growing role on the direction of the industry through 2023 and beyond.

ASCA Disappointed in Limited Selection

64 new procedures were recommended to CMS to be added to the ASC-CPL, including 47 recommended by the Ambulatory Surgery Center Association (ASCA). CMS selected four out of the 64 recommendations for addition to the ASC-CPL.

  • Mastectomy, including axillary lymph nodes, excluding pectoralis major (Code 19307)
  • Retrieval (removal) of intravascular vena cava filter, endovascular approach (Code 37193)
  • Biopsy or excision of lymph node(s); open, inguinofemoral node(s) (Code 38531)
  • Laparoscopy, surgical, gastric restrictive procedure (Code 43774)

Bill Prentice, Chief Executive Officer of ASCA, viewed the limited number of approvals as a detriment to the health of patients.

“CMS’s decision to add only four new procedures to the ASC-CPL for 2023 after ASCA proposed 47 procedures that ASCs are performing safely and successfully for private insured patients is a serious mistake and denies beneficiaries access to high-value care,” Prentice is quoted as saying via VMG Health’s report. “Forcing otherwise healthy Medicare beneficiaries to receive care in higher-cost settings for these procedures needlessly increases costs to the Medicare program and undercuts Medicare’s mission of serving as a responsible steward of public funds.”

To read the full report from VMG Health, click here.

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