By William Prentice, ASCA Chief Executive Officer
As we head into the final months of 2017, ASCA and members of the ASC community have already covered a lot of ground this year when it comes to the work we need to do to reach key decision makers who can help protect patient access to ASCs and the cost-efficient, top-quality care that ASCs provide. ASCs are now represented in more high-level policy discussions than ever before and helping to define policies for the future that will serve the best interests of patients who need outpatient surgical care.
National Advocacy Day
At ASCA’s annual meeting in Washington, D.C., this May, more than 300 ASCA members visited their members of Congress on Capitol Hill. During those visits, ASCA’s members asked their elected officials to support ASCs by cosponsoring the Ambulatory Surgical Center Quality and Access Act of 2017 (H.R. 1838/S. 1001). This bill would change the Medicare inflationary update factor that contributes to the growing disparity between ASC and hospital outpatient department (HOPD) payments.
Thanks to these constituent meetings and other outreach efforts regarding this bill that ASCA conducted this year, as this magazine goes to print, the legislation now has 50 cosponsors in the House and six in the Senate. You can learn more about that bill at www.ascassociation.org/asc-qaa-2017.
ASCA Meets with HHS
Secretary Price and CMS Administrator Verma
During June, ASCA was part of a roundtable discussion with U.S. Department of Health & Human Services (HHS) Secretary Tom Price, M.D., and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. Others at the meeting represented physician groups focused on specialties including anesthesia, orthopedics, ophthalmology and more. The session was designed to allow those involved to identify specific regulatory burdens that HHS could eliminate. Each organization present was given three minutes to present, and ASCA used that time to discuss Medicare’s ASC payment system and the procedures that ASCs are allowed to perform for the program’s beneficiaries.
First, ASCA pointed out that since ASC payments are tied to the HOPD payment system and both ASCs and HOPDs face the same increases in the cost of doing business each year (e.g., equipment, devices, implants, facility upkeep and staffing costs), ASC payment updates each year should be based on the same update factor as the hospitals. To accomplish that goal, ASCA recommended that CMS replace the Consumer Price Index for All Urban Consumers (CPI-U) with the hospital market basket as the update mechanism for ASC payments.
Second, ASCA asked CMS to begin reimbursing ASCs for all of the same surgical codes for which it reimburses HOPDs. At a minimum, ASCA asked CMS to add the codes recommended by industry clinicians.
In conjunction with that meeting, ASCA also submitted a form that identified nine areas where ASCs and ASC physicians are seeking relief. That document suggests changes in areas ranging from the definitions surrounding device-intensive procedures, the way the new Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey is administered and compliance with the new Life Safety Code requirements.
New Payment Models
Back in March, ASCA representatives met with staff from the Center for Medicare & Medicaid Innovation (the Innovation Center). The Innovation Center, with CMS, supports the development and testing of innovative health care payment and service delivery models.
At this meeting, ASCA member Scott Leggett gave a presentation on a bundled payment model in the ASC setting. Leggett is the chief executive officer of Surgery One, LLC, which co-manages four outpatient surgery centers located in San Diego County, California. The “ask” in this meeting was for the Innovation Center to consider a bundled payment model pilot program for total joint replacements performed in the ASC setting.
We expect that this meeting was just the first step in what could be a long process but found genuine interest in the proposal from the Innovation Center staff.
Patient Safety and Facility Design
In June, the Facility Guidelines Institute (FGI) announced the appointment of David M. Shapiro, M.D., to its board of directors. Shapiro is an anesthesiologist with extensive experience in ASC management and a past-president of ASCA. Among his many credentials, he is a Certified Administrator Surgery Center (CASC), a Certified Professional in Healthcare Risk Management (CPHRM) and certified in Health Care Quality Management.
Shapiro joined FGI’s Health Guidelines Revision Committee (HGRC) Outpatient Document Group during the 2018 Guidelines for Design and Construction revision cycle to represent the ambulatory surgery industry. The insight and guidance he provided there were of great importance to the HGRC as it endeavored to separate hospital and outpatient requirements into two separate documents to better meet the disparate and evolving needs of outpatient facilities.
Electronic Health Record Use Requirements and
Public Data Reporting
Also during June, ASCA submitted formal comments in response to the 2018 Inpatient Prospective Payment System (IPPS) proposed rule that CMS released in April. Provisions addressed in those comments relate to the required use of electronic health record technology by ASC-based physicians and the public release of data revealed in ASC accreditation surveys.
The 21st Century Cures Act enacted last year exempts ASC-based eligible professionals (EP), or certain physicians who furnish substantially all of their covered professional services in an ASC, from payment cuts in 2017 and 2018. CMS proposed two possible definitions for an ASC-based EP. One, which matches a comparable hospital definition, defines “substantially all” as 75 percent or more of the covered services. The second option sets that figure at 90 percent. ASCA supported the lower 75 percent threshold, consistent with the hospital-based EP threshold, and recommended CMS finalize this as part of the ASC-based EP definition in the final rule.
The larger issue for EPs who practice in ASCs, however, has been CMS’ interpretation that ASC encounters are currently being included in the denominator when determining whether an EP is a “meaningful user” of CEHRT. Given that no CEHRT exists for the ASC setting, this means that EPs who have more than 50 percent of their outpatient encounters in an ASC could face payment reductions. This impacts a much greater number of eligible providers, and since there is currently no CEHRT for ASCs, ASCA asked CMS to clarify that these encounters should not be counted in the denominator of any calculations that determine adequate use of CEHRT products.
On the accreditation front, CMS is proposing to require accrediting organizations with CMS-approved accreditation programs to post final accreditation survey reports and acceptable plans of correction (PoCs) on a public-facing website. Because access to meaningful data, rather than simply a large volume of data, is what provides real value to patients, ASCA recommended that CMS withdraw its current proposal. Instead, ASCA recommended that CMS bring together accreditation organizations, providers and suppliers, information technology experts, consumer research groups and others with expert knowledge of access to data available in the health care industry to assist CMS with identifying and developing opportunities for providing consumers with the appropriate data to support transparency and decision making.
Survey & Certification and Clinical Standards Staff
In yet another June meeting, ASCA president Rebecca Craig, RN, MBA, CNOR, CPC-H, CASC, met with ASCA staff and representatives from the Centers for Medicare & Medicaid Services (CMS) Survey and Certification Group and Clinical Standards Group. Takeaways from this meeting included:
• CMS’ commitment that Appendix L of the State Operations Manual, which ASCs often use to assess their compliance policies and prepare for surveys, will be updated to reflect new regulatory language related to implementation of the revised emergency preparedness requirements;
• CMS’ confirmation that language currently included in the State Operations Manual: Appendix L is not meant to preclude ASCs from having electronic health records; and
• CMS’s agreement that it would take under advisement concerns that ASCA raised about purely competitive reasons that can drive a hospital’s decision to refuse to enter into a transfer agreement with an ASC.
Much work remains, and ASCA and its members are continuing to work in all of these areas and others. I encourage everyone who works in or with an ASC to participate. If you would like to learn more about how to get involved, please contact Danielle Kaster at firstname.lastname@example.org.