In response to comments submitted in response to a proposed rule that was published in the August 31, 2007 Federal Register, the new CfCs define an ASC as a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission. The proposed rule would have provided that the patient's treatment was not expected to require an overnight stay, defined as requiring active monitoring by qualified medical personnel, regardless of whether it is provided in the ASC, after 11:59 p.m. on the day of admission.

The changes in the final rule will apply to outpatient services furnished by more than 4,000 HOPDs in general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, community mental health centers, children's hospitals, and cancer hospitals. CMS projects that hospitals will receive $30.1 billion in CY 2009 for outpatient services furnished to Medicare beneficiaries, up from $28.5 billion in projected payments for CY 2008. Furthermore, CMS expects to make payments of almost $3.9 billion in CY 2009 to more than 5,100 ASCs that participate in Medicare, compared with $3.5 billion projected for CY 2008.


The Medicare law now requires that the annual OPPS payment inflation update be reduced by 2.0 percentage points for certain hospitals that do not meet quality reporting requirements. The final rule adopts 4 new quality measures for imaging efficiency, increasing the number of quality measures that HOPDs must report in CY 2009 to receive the full update in CY 2010 from the current 7 measures to 11 measures. CMS will continue to consider for future years eighteen additional quality measures in areas ranging from screening for fall risk to cancer care that were identified in the CY 2009 proposed rule, as well as other quality and efficiency measures as appropriate.

Imaging Impact

CMS is also changing how it pays for imaging services when two or more imaging procedures from an imaging family are provided in one session to encourage greater imaging efficiency. The final rule creates five imaging composite APCs (such as multiple computed tomography (CT) procedures) performed in a single hospital session. The change will apply to certain ultrasound procedures, CT and computed tomographic angiography (CTA) scans with or without contrast, and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans with or without contrast.

More Industry Headlines