Don't you think it is time for Ambulatory Surgery Centers to have their own national organization devoted to their growing needs?  

The following are battles we face every day:

• Medicare reduces payments for interventional procedures in single- and multi-specialty surgery centers each year, and Medicare has been trying to eliminate interventional procedures from the ASC-approved list since 1998. 

• Commercial payers follow the Medicare trend, denying payment for interventional procedures not on the Medicare ASC-approved list; then they want to pay only a percent of Medicare reimbursement in some cases, which could be lower than Medicare reimbursement itself.

• Above all, Medicare payments now may be based on inconsistent hospital outpatient department payment rules and local medical review policies.

Since 1998, the American Society of Interventional Pain Physicians (ASIPP) has been fighting ASC battles and has logged some impressive results, such as:

• ASIPP started its fight in June 1998, when the CMS proposed a rule to base the ASC payment system on same APC as proposed for HOPD.  If implemented, 60% to 75% of interventional procedures would have been deleted with 40% of those remaining facing such significant cuts that it would have not been feasible for ASCs to perform any interventional procedures. For example, ASC Group 1 procedures being reimbursed at the time at more than $300 per procedure would have been cut to $110, or 80% of HOPD. ASIPP was successful in eliminating this proposed rule.

• In 2000, ASIPP was successful in adding nine replacement codes to the ASC-covered list.

• In 2003, the ASC final rule was published with most of the procedures already on the ASC-approved list preserved, even though they had been slated for removal. Three services, including disc decompression, were added; but no new codes were added. This was a great success for interventional pain management.
  
• In 2004, a new ASC-proposed rule was released, adding adhesiolysis.

• However problems continued to brew for ASCs, specifically interventional pain management ASCs.  Other ASC organizations, focused on major surgical services, are willing to sacrifice interventional pain management or do not recognize the impact on interventional pain management because interventional pain constitutes only 4% of surgical procedures

• Congress and other organizations are attempting to tie HOPD payment rates to ASC payment rates.
  • In August 2000, the HOPD prospective payment system was implemented, resulting in substantial cuts for interventional procedures with payments ranging from $120 to $180 for most interventional procedures.  Hospitals started refusing to schedule interventional pain procedures.
  • Many major programs were closing
  • In February 2001, ASIPP testified before the APC panel and presented new APC groupings of interventional pain procedures.
  • The APC panel listened to ASIPP's concerns about patient access and agreed to regroup with improvements in reimbursement of 200 to 400%. This additional reimbursement continues, which is good for ASCs’ future, compared to 2000 HOPD rates.

• In December 2001, a MedPAC report, requested by ASIPP, on paying for interventional pain services in ambulatory settings showed:
  • Payments for interventional pain management procedures in ASCs probably do not reflect current costs because the rates are based on old charge and cost data.
  • The list of covered procedures needs to be updated.  There were inconsistencies across local coverage policies.
  • In March 2003, the MedPAC report to Congress on Medicare payment policy is disastrous for ASCs.
  • Congress should eliminate the update to payment rates for ASC services for fiscal year 2004.  Congress should ensure that payment rates for ASC procedures do not exceed hospital outpatient PPS rates. (i.e. If ASC is paid at a higher rate, it will be reduced; whereas if ASC is paid at a lower rate, it will not be increased).
  • ASC payments are reduced by 7% across the board, saving $100 million per year, but hurting interventional pain management.

• In January 2003, the OIG reported:
  • 1 billion in savings for Medicare with uniform ASC and hospital payments. 
  • Equalized ASC and HOPD payment rates for the same procedures.
  • 72 procedures should be deleted from ASC approved list.

• In December 2003, the Medicare Modernization Act passed:
  • Payment rates to be frozen at 2003 rates.
  • New ASC payment methodology must be implemented by January 2006.
  • GAO should recommend whether to use the outpatient PPS's procedure groups and relative weights as the basis for the ASC payment system.

• ASIPP has been working with GAO to prevent cuts for interventional procedures

• In March 2004, MedPAC recommends for ASC reimbursement:
  • No update to payment rates for ASC services for fiscal year 2005.
  • Good news in this report.  After the ASC payment system is revised, it will replace the current list of approved ASC procedures with a list of procedures excluded from payment based on clinical safety standards and whether the service requires an overnight stay.  (ASIPP strongly supports this).

Consequently, we continue to struggle to preserve interventional pain management and be reimbursed at reasonable costs in addition to adding the new procedures.  That’s why we need the new Society of Interventional Pain Management Surgery Centers.