by William Prentice
In Washington, D.C., and across the country, those who work to influence legislative and regulatory policy have a (frequently overused) saying: “If you are not at the table, you are on the menu.” ASCA and its members have made some important progress this past year by making sure that we are at the tables where ASCs need to be represented and making the conversations that we have at those tables count.
During August alone, ASCA staff and members met with Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, members of the Medicare Payment Advisory Commission (MedPAC) and new National Coordinator for Health Information Technology Karen DeSalvo, M.D.
With Administrator Tavenner, we touted the ASC community’s high level of participation in the first phase of the Medicare ASC Quality Reporting Program and discussed the need to add additional measures that produce meaningful results for ASCs and their patients. We also talked about the need to close the ever-widening gap between ASC and hospital outpatient department (HOPD) payment rates to prevent the unfortunate consequences of the ASC to HOPD conversions that we are seeing in the marketplace as a result. One of those consequences that we emphasized is forcing patients into the higher cost HOPD setting and increasing costs to the Medicare program and its beneficiaries absent any gains in quality of care or patient satisfaction with the services provided.
At our meeting with MedPAC, the independent advisory body that makes recommendations to CMS and Congress on Medicare payment policy, we again addressed the need to stem the growing divide between ASC and HOPD payments. We also pointed to the growing threat of the reverse migration of cases into the higher cost HOPD setting. We were encouraged by the interest that MedPAC staff showed in several of the issues that we raised in the meeting.
In our conversation with Dr. DeSalvo, who is responsible for directing the federal government’s development of health information technology (HIT) standards and strategy, we talked about the barriers that ASCs face in adopting electronic health records (EHR). We also discussed the development of standards for a voluntary certification process for EHRs in the ASC setting. She and her staff indicated that they were receptive to further dialogue on our issues.
Throughout this year, of course, ASCA and its members have also continued their conversations with CMS staff on issues involving everything from how to interpret and comply with Medicare’s newest regulatory requirements to how to craft quality measures that produce meaningful results for ASC patients. As in years past, ASCA also submitted extensive comments on CMS’ proposed ASC payment rule for the coming year. In our comments this year, we supported CMS’ proposal, made following ASCA’s request, to expand the list of procedures that Medicare will reimburse ASCs for providing. We also supported the agency’s proposed changes to reimbursement policies regarding device-intensive procedures, something that ASCA has long been requesting for a long time. Again, we raised our concerns with the growing disparity in ASC and HOPD reimbursement rates.
This year, ASCA also submitted comments on CMS’ proposed rule affecting the physician payment rule. Our comments to that proposal addressed the agency’s suggestion to eliminate 10- and 90-day global surgery periods in 2016 and proposed changes to the definition of colorectal cancer screening tests.
Work that ASCA and its members did with the Facility Guidelines Institute (FGI) in the past year also resulted in some changes in that organization’s final guidelines that will affect future ASC expansion and new construction projects. Again, our intervention targeted proposed changes that would have imposed unreasonable — and, in this case, costly — measures that would produce little benefit for patients in the ASC setting. In FGI’s final rule, we didn’t see all of the changes that we requested, but we expect that those that were adopted will be very beneficial for ASCs down the line.
In September, ASCs also saw a Drug Enforcement Agency (DEA) response to comments ASCA and others submitted back in February 2013 on the agency’s proposed rule governing drug disposal. In DEA’s final rule on that issue, ASCs saw several changes that reduce the burden that the agency’s regulatory requirements place on ASCs while continuing to ensure that drugs are handled safely in our facilities and sound environmental protections remain in place. More work remains.
And all of that was just on the regulatory side. In Congress, ASCA and its members also gained a lot of ground on a number of diverse legislative initiatives.
In June and September, ASCA conducted two Capitol Fly-In events. In all, more than 150 ASCA members, individually and in groups, conducted more than 200 meetings with their members of Congress and their staff on Capitol Hill. The participants hailed from 31 different states. So far this year, working with ASCA, ASCs also conducted 43 facility tours for their elected officials and other key policy makers. We reached a high water mark of 20 tours during August when ASCs celebrate National ASC Day. More tours are scheduled before the end of the year. Independent of these congressional visits, ASCA staff also conducted more than 380 meetings on Capitol Hill this year.
In all of these visits, the key messages to members of Congress were the same: please support the ASC Quality and Access Act, pending legislation that would encourage colorectal cancer screenings for those in need and pending legislation that would resolve some of the difficulties ASC physicians could encounter with the meaningful use requirements associated with electronic health records. We also emphasized that ASCs provide top quality, lower cost outpatient surgical care and need the support of state and national policymakers to be able to continue to provide that care … not just to Medicare beneficiaries but to all patients in need of the services ASCs provide. Record numbers of congressional cosponsors have signed on to the legislative initiatives that ASCA and its members highlighted during these meetings with their members of Congress.
In July, the ASC Quality Collaboration and ASCA led the way to ensuring patient access to high quality outpatient surgical care by convening an ASC Quality Leadership Conference in Washington, D.C. That meeting attracted nearly 50 renowned leaders in healthcare quality, and many who participated had an opportunity to meet and interact face-to-face for the first time. Many also expressed their gratitude for this opportunity to come together and make connections. ASCA and those who attended hope to build on this event in the future.
This long list still describes only some of the many policy-related activities and conversations in which ASCA and its members were involved this year. It also omits a number of important initiatives involving ASCA and ASCA members at the state level. As part of our commitment to doing all that we can to support ASCs in providing top-quality surgical care at reasonable prices, while meeting and exceeding the expectations of patients and providers for service, outcomes and care, we will continue to be involved at these tables and to expand our outreach in 2015.
As always, if you work in an ASC or support the ASC model of care as we do, I encourage you to learn more about the work that ASCA and the ASC community are doing by visiting our web site at www.ascassociation.org. I also encourage you to contact us directly with specific questions or comments by email at email@example.com. If you work in an ASC that is not currently a member, please contact Mykal Cox at firstname.lastname@example.org or 703.836.8808 x 114.
William Prentice is the chief executive officer of the Ambulatory Surgery Center Association.