Payer ASCs could get more Medicare customers, more quality requirements after CMS rule

by Robert King | Aug 9, 2019

As the Trump administration expands traditional Medicare coverage in ambulatory surgical centers (ASCs), the industry will face new quality requirements and concerns about costs.

The Centers for Medicare & Medicaid Services (CMS) proposed last week that it will extend Medicare coverage to ASCs for total knee replacements and several coronary procedures. The decision follows Medicare Advantage plans that frequently turn to ASCs for knee replacements.  

But the proposal includes new quality reporting requirements for ASCs.

CMS proposed adding a new measure for its ASC quality reporting program. The new measure would determine whether there is an unplanned hospital visit seven days after a general surgery is performed at an ASC. The measure, which goes into effect in 2022, resembles quality measures such as readmissions that hospitals need to lower or face cuts to Medicare payments.

One expert said that the proposed quality measure could signal ASCs may face the same fate.


Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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