WASHINGTON—The American Academy of Ophthalmology today announced that it is encouraged by the May 4, 2005, issuance of the Centers for Medicare and Medicaid Services (CMS) interim final rule on the list of Medicare approved ambulatory surgical center (ASC) procedures. The rule revises the ASC list to include 10 procedure codes that the Academy had been actively urging CMS to cover. Also, in response to the Academy’s pressure, CMS kept 15 ophthalmic codes on the ASC list that were originally slated for deletion. Winning CMS approval of ophthalmological procedures that can be done safely and cost effectively in ASCs continues to be a high priority for the Academy’s federal advocacy efforts.

Despite these gains, the Academy is still frustrated by the slow process by which CMS is updating the ASC list, particularly since Congress mandated more than 10 years ago that the ASC list undergo a comprehensive update. The lengthy review process means that Medicare beneficiaries will not receive some of the latest, most effective and most cost-efficient treatment options for years. The Academy, therefore, is committed to promoting real solutions to the fundamental structural problems of the ASC coverage process.

The Academy is primarily focused on changing the basic nature of the list – from an inclusive list to an exclusive list. The Medicare Payment Advisory Commission (MedPAC), an independent body established to advise congress on Medicare issues, also supports the idea of an exclusive list.  In a 2004 report, MedPAC argued that CMS should replace the current list of Medicare-approved ASC procedures with a list of procedures expressly excluded from Medicare payment, based on clinical safety standards and required overnight stays.

“The Academy and MedPAC agree – the ASC list should be changed from an inclusive list to an exclusive one,” said William Rich III, MD, the Academy’s medical director of health policy. “An exclusive list would cover all procedures that the medical profession has deemed safe and appropriate to perform in an ASC setting. This would accomplish our common goal of providing safe, timely, and high quality health care to Medicare beneficiaries.”

The Academy acknowledges that CMS is unlikely to change the current coverage process until payment reforms mandated by the Medicare Modernization Act (MMA) are achieved. Effective last year, the MMA requires CMS to revise its payment system for ASC facility services no earlier than Jan. 1, 2006, and no later than Jan. 1, 2008.

The Academy supports the Outpatient Ophthalmic Surgery Society as it leads the profession’s efforts to achieve a fair and balanced revised payment system for facility services.

“With the rapid growth in the use of ASCs by its members, the Academy is committed to ensuring that Eye M.D.s have the option of using an ASC when it is in the best interest of their patients,” said Catherine Cohen, the Academy’s vice president for governmental affairs.