CMS finalized a reimbursement increase of 2.9% for ASCs meeting quality reporting requirements next year.
The update, published Nov. 1 in CMS' 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, is based on a projected hospital market basket percentage increase of 3.4%, and then a 0.5 percentage point productivity adjustment.
Three ASC leaders joined Beckers' to discuss their thoughts on CMS' ASC pay increase:
Tina Heinrich. Administrator and Director of Nursing at El Dorado Surgery Center (Placerville, Calif.): CMS is not afraid to increase our costs by requiring reporting on patient satisfaction through only their chosen vendors, (our costs rose significantly for this). Too bad they are so slow in increasing reimbursement amounts.
Robert Nelson, PA. Vice President of Business Development for EyeProGPO(Watkinsville, Ga.). We are basically satisfied with the 2025 ASC update, although, of course, we would have liked to see higher rates. Our industry lived for 30 years with no increases, or marginal increases via the prior consumer price index methodology. It has been a major goal of the ASC and ophthalmology communities to be paid using the same update methodology as hospital outpatient departments. After all, ASCs treat the same patients with the same conditions and comorbidities as do hospitals, and we consume the same resources (staff, equipment, supplies) as HOPDs.
Starting in 2019, CMS granted our request on a seven-year trial basis and we are hoping to retain the hospital market basket update as CMS determines for CY 2026 what our permanent update will be. ASCs have received a positive hospital update for 26 years. Physicians have rarely had anything but cuts in their professional fees over the same period. Our update rates ebb and flow as CMS annually links HOPD and ASC rates. For example, while this year cataract facility fees increased by 2.6 percent, just last year our increase was 7.5%. While the new percentage increases were not huge, several important ophthalmic procedures received meaningful increases. Vitrectomy up $50, goniotomy up $50, cataract with stent, up $64, cataract with ECP up $50, to name a few. Any increase is helpful going forward, but there will be other payment and regulatory issues that will more significantly affect our rates and overall business success going forward than a cost-of-living adjustment. These include Medicare carriers attempting to arbitrarily place limits on facility payments for critical eye services; securing more expansive coverage and payment of device-intensive procedures; coverage and payment for drugs administered during cataract surgery; and new quality reporting measures which, if not complied with, will result in 2% cuts in our annual updates.
Lauren Phillips. Director of Invasive Services at The Cardiac & Vascular Institute (Chiefland, Fla.): CMS finalizing a reimbursement increase for ASCs is a huge win. Working in an ASC daily I see first hand the exceptional care that is delivered to patients being able to have procedures safely done in the outpatient ASC setting. The cost of these procedures is also much less out of pocket for patients than if they were to have the procedure done in the hospital setting. We are working hard daily to make sure we are delivering high quality care and would love to be able to continue to do that and to be able to increase the types of the procedures that are approved in the outpatient setting. The ASC that I work for is cardiology and vascular based, this is a fairly new specialty for ASCs that is growing. Reimbursement increases as well as additional procedures being approved is a huge win for ASCs and the patients.