The Medicare Payment Advisory Commission (MedPAC), an independent federal advisory commission that provides Congress with analysis and policy advice on the Medicare program, recently issued its 2018 report. Within this report is a chapter dedicated to ambulatory surgery centers (ASCs). This chapter provides recommendations concerning ASC Medicare payment systems and includes some interesting ASC statistics.
Here are 10 key takeaways from the report.
1. MedPAC recommended that Congress eliminate the calendar year 2019 update to ASC Medicare payment rates. MedPAC’s rationale: “The volume of services per beneficiary declined slightly in 2016, the complexity of services provided increased, and the number of ASCs increased. Also, ASCs appear to have adequate access to capital, and Medicare payments to ASCs have continued to grow. Moreover, even though we do not have cost data and we have reservations about the quality data, the indicators we have suggest that payments have been adequate.”
2. MedPAC recommended that the Secretary of Health and Human Services require ASCs to report cost data. MedPAC’s rationale: “Cost data would enable the Centers for Medicare & Medicaid Services (CMS) and [MedPAC] to examine the growth of ASCs’ costs over time and evaluate Medicare payments relative to the costs of an efficient provider, which would help inform decisions about the ASC payment update. Cost data are also needed to evaluate whether an alternative input price index would be an appropriate proxy for ASC costs.”
3. MedPAC recommended CMS use cost data to examine whether an existing Medicare price index is an appropriate proxy for ASC costs or an ASC-specific market basket should be developed, noting the following: “A new ASC market basket could include the same types of costs that appear in the hospital market basket or Medicare Economic Index but with different cost weights that reflect ASCs’ unique cost structure.”
4. MedPAC noted that services provided in ASCs rather than hospital outpatient departments (HOPDs) is less costly to beneficiaries. Cost sharing is higher under the ASC payment system for only 84 of 3,456 HCPCS codes covered under the ASC payment system.
5. Medicare payment rates for most surgical services are 92% higher in HOPDs than in ASCs.
6. From 2011 to 2015, the number of ASCs grew at an average annual rate of 1.3%. In 2016, the number of ASCs increased 1.4%. Ninety-two percent of these new ASCs in 2016 were for-profit facilities.
7. From 2006 to 2016, the number of ASCs grew by 23%, from 4,490 to 5,532.
8. In 2016, the number of new ASCs (142) more than doubled the number that closed or merged (63).
9. Outpatient surgical procedures decreased in ASCs and increased in HOPDs in 2016. From 2011 through 2015, average annual growth in volume per fee-for-service (FFS) beneficiary of surgical services covered by the ASC payment system was 0.7% in ASCs and 1.4% in HOPDs. In 2016, volume per FFS beneficiary decreased by 0.5% in ASCs and increased by 3.2% in HOPDs. One possible explanation for the higher growth of surgical services in HOPDs relative to ASCs over the 2011 through 2016 period offered by MedPAC was the following: “Medicare payment rates have become much higher in HOPDs than in ASCs, which might make it less financially attractive to provide surgical services for Medicare patients in ASCs.”
10. MedPAC identified two possible new measures it believed might allow for better assessment of the quality of care provided in ASCs: 1) number of Medicare beneficiaries discharged from ASCs who had a subsequent unplanned hospital visit and 2) rate of surgical site infections occurring at ASCs.
Ambulatory surgery center (ASC) infection preventionists now have a credential they can call their own.
The Board of Ambulatory Surgery Certification (BASC) recently announced the launch of the Certified Ambulatory Infection Preventionist (CAIP) credential. CAIP is designed specifically for infection preventionists working in ASCs.
To earn the CAIP credential, candidates must meet a few requirements concerning their licensure, responsibilities and experience. They must also pass a 150-multiple-choice exam that tests knowledge in several ASC infection prevention and control areas, including program development and implementation; education and training; surveillance and data collection; and equipment cleaning and disinfection.
The first CAIP exam will be an online test held throughout this October. Individuals interested in testing this year must have earned 10 contacts hours in infection prevention over the last two years.
“Considering the high priority placed on infection prevention in the ASC setting,” said Gina Throneberry, RN, CASC, executive director of BASC, in the announcement, “BASC decided that it would be worthwhile to create a credential to help ASC professionals demonstrate their expertise in this area and commitment to remaining current on best practices in infection prevention and control.”
BASC also developed and oversees the Certified Administrator Surgery Center (CASC) credential.
Learn more about CAIP here.
Results of a new study indicate that ASCs are now the preferred setting for a healthy majority of cataract surgery procedures.
The study, conducted by University of Michigan Kellogg Eye Center researchers, shows that 73% of cataract surgeries were performed in surgery centers in 2014. That’s up from about 44% in 2001.
The study, published in JAMA Ophthalmology, examined cataract surgery claims data from 2001–2014 for about 369,00 enrollees age 40 and older who were part of a nationwide managed care network.
Patients were more likely to undergo cataract surgery at an ASC if they:
A Michigan Medicine news release noted that while well-equipped hospitals are more prepared than an ASC if medical complication occurs, surgery centers are an attractive setting thanks to their convenience, lower out-of-pocket costs for patients and decreased cost-per-case for insurers.
The release also noted that an analysis estimated that cataract surgeries performed at ASCs rather than hospitals saved Medicare more than $800 million in 2011.
The Centers for Medicare & Medicaid Services recently issued its 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System final rule. It addresses several updates ASCs will want to understand, including changes to the Ambulatory Surgical Center Quality Reporting (ASCQR) Program and payment rates.
Here are five of the most significant takeaways.
1. OAS CAHPS implementation delay. CMS is delaying the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR program for 2018 data collection (connected to 2020 payment determination).
2. Payment increase of 1.2%. ASCs that meet the quality reporting requirements under the ASCQR Program will receive an effective payment update of 1.2% on average for all covered procedures. This increase is lower than what was in the proposed rule (1.9%). Actual updates will vary by code and specialty.
Based on this update, CMS estimates that total payments to ASCs — including beneficiary cost-sharing and estimated changes in enrollment, utilization and case-mix — for CY 2018 is approximately $4.62 billion, an increase of approximately $130 million compared to estimated CY 2017 Medicare payments.
3. Addition of two measures to ASCQR Program. The ASCQR Program is the pay-for-reporting program that requires ASCs to meet requirements or receive a reduction of 2.0 percentage points in their annual payment update.
CMS is adding two measures to the ASCQR program measure set for the 2021 and 2022 payment determinations and subsequent years. The measures are as follows:
CMS had proposed adding the “ASC-16: Toxic Anterior Segment Syndrome (TASS)” measure beginning with the 2021 payment determination, but chose not to finalize its addition.
4. Removal of three measures from ASCQR Program. CMS is removing three measures for the 2019 payment determination and subsequent years. The measures are as follows:
5. Total knee arthroplasty removed from IPO. CMS is removing total knee arthroplasty from the Medicare inpatient-only (IPO) list for 2018. This list identifies procedures that are only paid under the Hospital Inpatient Prospective Payment System.
The Centers for Medicare & Medicaid Services (CMS) has announced it will grant exceptions for Medicare quality reporting requirements to ASCs in areas affected by Hurricanes Harvey and Irma, according to the Ambulatory Surgery Center Association (ASCA).
ASCs will receive exceptions without having to submit an extraordinary circumstances exception (ECE) request if they are located in counties, parishes, municipios or county-equivalents designated by the Federal Emergency Management Agency (FEMA) as a major disaster location.
ASCs located outside of the designated areas may submit ECE requests based on individual circumstances.
Ambulatory surgery centers (ASCs) nationwide are celebrating National ASC Week, which begins today, August 7 and runs through August 11.
Over the past decade, numerous ASCs have hosted events — “ASC Days” — designed to educate the community and key policy and decision makers about the high-quality, low-cost surgical services provided in surgery centers.
Events include inviting elected officials for tours and hosting open houses to provide information to healthcare consumers.
The Outpatient Healthcare Strategies team hopes its partner ASCs, and all surgery centers, have a great National ASC Week. Thank you for what you do for millions of patients every year!
For more information about National ASC Week, click here.
The Centers for Medicare & Medicaid Services recently issued its 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule.
It includes several proposed updates that should be interest to ASCs, including changes to quality provisions and payment rates.
Here are five of the key takeaways for ASCs to know.
1. OAS CAHPS implementation delay. CMS is proposing to delay the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the Ambulatory Surgical Center Quality Reporting (ASCQR) Program for 2018 data collection (connected to 2020 payment determination).
ASCs that would like to continue to administer the survey under the voluntary national implementation would be permitted to do so in 2018.
2. Payment increase of 1.9%. CMS is proposing to provide ASCs an effective payment update of 1.9% on average for all covered procedures. Actual updates may vary by code and specialty.
3. Significant changes to ASCQR Program. The ASCQR Program is the pay-for-reporting program that requires ASCs to meet requirements or receive a reduction of 2.0 percentage points in their annual payment update.
CMS is proposing to add three measures to the ASCQR program measure set for the 2021 and 2022 payment determinations and subsequent years. The three proposed measures are as follows:
CMS is proposing to remove three measures for the 2019 payment determination and subsequent years. The three measures proposed for removal are as follows:
4. Total knee arthroplasty removed from IPO. CMS is proposing to remove total knee arthroplasty from the Medicare inpatient-only (IPO) list. This list identifies procedures that are only paid under the Hospital Inpatient Prospective Payment System.
CMS is also seeking comment regarding whether partial and total hip arthroplasty should be removed the IPO list.
5. Comments on payment reform. ASC payment rates are tied to data derived from the OPPS. CMS noted that given concerns about the difference between OPPS payments relative to ASC payments (56% in 2017), CMS is soliciting comments on ways to improve payment accuracy to ASCs and on the collection of ASC cost data.
CMS will accept comments on the proposed rule until Sept. 11, 2017. It will respond to comments in a final rule on or about Nov. 1, 2017.
The Centers for Disease Control and Prevention (CDC) has updated its “Guideline for the Prevention of Surgical Site Infection.”
Published in the JAMA Surgery journal, the 2017 SSI guideline updates the last version, which was published in 1999.
CDC conducted a “targeted systematic review” of nearly 5,500 studies published from 1998 through April 2014. Findings include the following:
As CDC notes, recommendations made in the guideline should be incorporated into surgical quality improvement programs.
To review all of the findings and in greater detail, view the new SSI guideline.
Consumer Reports recently published a detailed reported on surgery centers covering a wide range of topics, including the advantages of outpatient surgery and how to select the right ASC for a procedure.
The column is titled “Get the Best Care at an Ambulatory Surgery Center.” Here are some of its key takeaways:
1. ASCs are expanding their scope of services. They are increasingly taking on more complex procedures, such as total joint replacement and spine surgery, while capturing more volume of complicated procedures such as hysterectomies.
2. Outpatient surgery offers numerous advantages. These include shorter stays, typically lower costs for patients, and lower rates of complications such as urinary tract infections and blood clots.
3. ASCs are great settings for many people. But not all. Consumers in good health are the strongest candidates for surgery in an ASC. If consumers are older and/or have health conditions and comorbidities (e.g., obesity, hypertension, history of heart attack or stroke), they are likely at increased risk of complications. In such cases, it is advisable for consumers to speak with their doctor to help determine the most appropriate setting.
4. Research is wise. Before consumers settle on a location for their outpatient surgical procedure, they should perform due diligence on the site and procedure. Consumer Reports recommends researching the following:
– Complication rates associated with the procedure and performing surgeon
– Certification from the Centers for Medicare & Medicaid Services (CMS)
– Surgeon experience performing the procedure
– Type of anesthesia and monitoring process
– Emergency and transfer plan
5. Prepare for recovery. To help reduce the risk of complications following their procedure, consumers should leave the facility only when feeling well, make sure to receive written discharge instructions, pre-arrange home support, and share any medical concerns during the follow-up call.
Access the Consumer Reports column here.
Representatives of Outpatient Healthcare Strategies (OHS) will be attending ASCA 2017, the annual meeting of the Ambulatory Surgery Center Association (ASCA).
ASCA 2017 takes place May 3–6 in Washington, D.C. The meeting brings together thousands of representatives from ambulatory surgery centers (ASCs), industry experts, and product and service providers for several days of education and networking.
ASCA is the national membership association that represents ASCs and provides advocacy and resources to assist ASCs in delivering high quality, cost-effective ambulatory surgery to all the patients they serve.
Outpatient Healthcare Strategies President and Founder Jessica Nantz discusses payer contracting in a new column to Becker’s ASC Review.
The article is titled “6 ASC payer contracting missteps to avoid.”
In the piece, Ms. Nantz notes that payer contracting is not an easy or quick process, and ASCs often settle for less-than-satisfactory contracts. She identifies six common mistakes ASC administrators make when negotiating with payers.
To access the article, click here.
Arthur E. Casey, senior vice president of Outpatient Healthcare Strategies, is featured in a new Becker’s ASC Review column.
The article is titled “Finding the perfect fit: 3 areas of focus when recruiting physician investors.”
In the piece, Mr. Casey discusses the importance of ambulatory surgery centers bringing in new investors, specifically those that are a good fit for the ASC in terms of personality, cost-effectiveness and the desire to be a business owner.
To read the article, click here.
Outpatient Healthcare Strategies President and Founder of Outpatient Healthcare Strategies Jessica Nantz has contributed a new column to Becker’s ASC Review.
The article is titled “Hybrid ASC self-management model: 8 benefits to know.”
In the piece, Ms. Nantz discusses the “hybrid self-management model,” in which an ASC contracts with an individual(s) or company with knowledge in ASC clinical and/or financial management operations. She then identifies and explains eight benefits of the model.
To access the article, click here.
Ambulatory surgery center consultant and President and Founder of Outpatient Healthcare Strategies Jessica Nantz has contributed a new column to Becker’s ASC Review.
The article is titled “The alternative ambulatory surgery center management model: 6 things to know.” Ms. Nantz begins the piece by discussing the merits of the most common functional management models for ASCs before identifying a frequently overlooked model ASCs should be considering: the hybrid of the independent self-management model. In this model, the ASC contracts with an individual(s) or company with extensive knowledge in ASC financial management and clinical operations. Ms. Nantz explains six reasons for ASCs to consider this model.
To access the article, click here.
Outpatient Healthcare Strategies has once again been named an ambulatory surgery center (ASC) management and development company to watch by Becker’s ASC Review.
The profile for the company reads as follows:
Outpatient Healthcare Strategies provides operational, financial, clinical and business strategies for ASCs, physicians and hospitals. The company helps with payer contracting, benchmarking, clinical assessments and joint ventures, among other services. Founder of Outpatient Healthcare Strategies, Jessica Nantz serves as president and CEO. Equipped with 15 years of experience in the outpatient healthcare industry, Ms. Nantz has operated and managed more than 80 facilities, including ASCs.
To view the list of ASC management and development company to watch in 2016, click here.
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