By Bill Prentice
With confirmed cases of COVID-19 at an all-time high and several states and hospital systems again suspending elective surgeries, the first quarter of 2021 is setting the stage for another challenging and unpredictable year. It can help to remember that we have already received some good news for 2021 and could see more before year-end.
ASCs Deliver Safe Surgery Despite Pandemic
The good news for patients in need of outpatient surgery is that, across the country, health care providers and policymakers have recognized that elective surgery is not the same thing as optional surgery and are allowing ASCs to remain open to provide this care. Patients who elected to postpone the surgery they needed after the coronavirus was discovered in the U.S. about a year ago are finding that ASCs can safely provide their care, even during the pandemic, and taking advantage of the opportunities ASCs offer.
The good news inside ASCs is that the new patient safety precautions that facilities have adopted since the pandemic was declared, including masking and social distancing, are leading to high-quality outcomes and extremely rare reports of patients contracting COVID-19 following a procedure in an ASC. Two surveys – one conducted by the ASC Quality Collaboration and involving 700 facilities and the other conducted by ASCA and involving 631 facilities – confirm that finding.
The presence of the coronavirus in the U.S. has also led many ASCs to review their infection prevention policies and procedures as well as intensify their focus on making sure they are doing all they can to protect their patients and staff from infections of any kind. In fact, last July, I talked about the risks involved in delaying certain elective surgeries with board-certified gastroenterologist and former ASCA board member Tom Deas, MD. Deas suggested that by that time, thanks to new protocols that were developed and adopted nationally to prevent the spread of the virus, ASC endoscopy units had probably become some of the safest places on earth when it came to avoiding COVID-19. ASCs might be far safer, he suggested, than a post office, barber shop or restaurant. He also said he would be perfectly comfortable having an endoscopic procedure in an ASC that had implemented the new protocols. Anyone interested in that conversation can go to the July 15, 2020, episode of ASCA’s Advancing Surgical Care Podcast, “The Risk of Delaying Certain Elective Surgeries,” to hear more.
Vaccine Distribution Continues
One of the biggest developments in the country’s battle against the coronavirus this year, of course, is the rollout of the vaccine that began late last year. Health care and frontline emergency workers were receiving some of the earliest available vaccines and, in most states, ASC staff were high on the list of those next in line. If the vaccines work as expected, people across the country could begin to see significant changes in the restrictions they have been under in the last year.
Medicare’s New Payment Rule Allows More Procedures at ASCs
Medicare’s 2021 final payment rule also contained some good news for ASCs and their patients. For one, the rule adds 267 procedures, including total hip arthroplasty, to the ASC Covered Procedures List (ASC CPL) beginning this year. That means that more Medicare beneficiaries can have more of the outpatient surgery they need in an ASC. ASCs that have been performing total hip arthroplasty and seeing excellent outcomes in their privately insured patients for some time are particularly pleased to see that procedure now available to Medicare beneficiaries in ASCs.
In other good news this year, thanks to the continued use of the hospital market basket to set both ASC and hospital outpatient department (HOPD) payment rates, ASCs and HOPDs got the same 2.4% inflation update. The use of the hospital market basket in determining the annual updates for both entities is something the ASC community has been requesting for some time, and although we are still in a trial period, we are pleased to see that CMS is continuing with its plan to evaluate the use of that measure to set the updated rates for both ASCs and HOPDs. While other parts of the Medicare payment system still need to be addressed, this one change could help slow the steadily increasing disparity between ASC and HOPD rates that we have seen since the current ASC payment system was introduced in 2008.
End-of-Year Legislation Offers Policy Updates and Financial Relief
Other positive news for ASCs and their patients in 2021 came in end-of-year legislation that was signed into law late in December. After years of requests from ASCA and many others, that new law, known as the Consolidated Appropriations Act, 2021, creates a fix to the patient copay penalty invoked whenever a screening colonoscopy transforms into a diagnostic colonoscopy with the removal of a polyp. The Medicare beneficiary copay now in place will be phased out between January 2022 and January 2030.
This legislation also authorized additional financial assistance to businesses that have experienced financial losses during the pandemic and makes clear that, for tax purposes, gross income will not include any amount that would arise from the forgiveness of a Paycheck Protection Program loan. As a way of offsetting some of the financial uncertainty ASCs and other health care providers have experienced since the temporary halt of elective surgeries early last year, the legislation also continues to suspend sequestration through March 31, 2021. That suspension means that providers are fully reimbursed for the services they provide to Medicare patients until sequestration payment reductions are reactivated. ASCA and its members had advocated for all of those actions.
Support for ASCs on Capitol Hill
While it is too soon to say for sure exactly what the ASC community can expect from the new administration, we do know that many ASC champions are returning to the U.S. Congress and are poised to assume key positions on committees with jurisdiction over our issues. ASCs, however, have always enjoyed support from both sides of the aisle. ASCA and its members continue to cultivate bipartisan support for the ASC community by educating all members of Congress about the many benefits ASCs provide. After retooling our ASC tour program last year, in response to the coronavirus quarantines, we now have a virtual tour toolkit to support these efforts. Anyone interested in learning more about these efforts should contact ASCA’s Director of Government Affairs and Regulatory Counsel Kara Newbury at email@example.com.
ASC Advocacy Continues
We are pleased to see several of the policies that ASCA and its members have long supported being adopted this year. We are also grateful that the ASC community was consulted and considered as a national response to the coronavirus pandemic was coordinated. Still, we have a great deal of work ahead of us in 2021 and beyond and recognize that ASCs are most effective when they speak with a united voice. ASCA continues to stand ready to be that voice, to convene the conversations needed to address new challenges and to continue to work to achieve the legislative and regulatory policies needed to serve the ASC community and the patients who need the care that ASCs provide.