Against strenuous objection from hospital trade groups, ambulatory surgery centers can start receiving reimbursement for fee-for-service Medicare beneficiaries undergoing total knee replacement and mosaicplasty procedures, coronary angioplasties, and placements of stents starting Jan. 1. "We have determined these procedures would not be expected to pose a significant risk to beneficiary safety when performed in an ASC," the Centers for Medicare & Medicaid Services said in its final outpatient rule released Friday. The agency added its belief that "standard medical practice would not dictate that the beneficiary would typically be expected to require active medical monitoring and care at midnight following the procedure." The American Hospital Association, which previously had attacked the agency's proposed rule on multiple grounds, said Friday the agency's policy shift could harm beneficiaries. "It is very disappointed that CMS chose to finalize this policy and we continue to believe that it is not clinically appropriate. We are concerned that this decision will pose serious risks and have negative quality of care implications for vulnerable Medicare patients," said Roslyne Schulman, director of AHA policy. Hospital officials asserted that, should a complication develop in an ASC patient, appropriate backup expertise is not as readily available in an ASC as it is in a hospital outpatient department or inpatient setting. The ASC must summon an ambulance and get that patient to an appropriate higher level of care setting, which may be many miles away. (ASCs, on the other hand, pointed out that many hospital-affiliated clinics are no less remote and also would require ambulance transport in the event of serious complications.) "Nearly half of all Medicare beneficiaries live with four or more chronic conditions, and one-third have one or more limitations in activities of daily living (ADL) that limit their ability to function independently ... (and) make even simple procedures more complicated," the AHA said. CMS also declined to require that ASCs "have a certain amount of experience in performing a procedure before being eligible for payment for performing the procedure under Medicare," as hospital groups had sought. And the agency was not persuaded by the AHA's argument that the policy change would hurt beneficiaries financially, costing them more out-of-pocket. Because outpatient department procedures have a Medicare-imposed deductible cap, total costs are lower for procedures performed there than in an ASC.