Outpatient Healthcare Strategies President and Founder Jessica Nantz shares her thoughts on ambulatory surgery center (ASC) trends, developments and predictions in a new Q&A article in Becker’s ASC Review.
The article sees Nantz share her thoughts on the following questions:
Topics Nantz discusses include the growth of total joint replacement and cardiology programs, implications of the 2019 final payment rule, expansion of Medicare’s ASC payable list, shortage of operating room circulators and scrub techs, and the ongoing migration of higher-acuity procedures into ASCs.
Access the Becker’s ASC Review article.
We’re still trying to catch our breath from what turned out to be quite a very busy and active summer for the ASC industry. There were major proposed rules and announcements that will likely drive significant new trends and that reflect developments gaining momentum.
Here are some of the most substantial ASC news from the summer, summarized to help you keep current on the trends and developments that may soon impact your center — if they’re not doing so already.
1. CMS releases 2019 proposed Medicare payment rule. In July, the Centers for Medicare & Medicaid Services (CMS) issued its proposed payment rule for ASCs (and hospital outpatient departments (HOPDs)). Key take takeaways include the following:
2. House passes Ambulatory Surgical Center Payment Transparency Act of 2018. Also in July, the US House of Representatives passed the Ambulatory Surgical Center (ASC) Payment Transparency Act of 2018 (H.R. 6138). Key takeaways include the following:
If eventually approved as law, these changes would strengthen the ASC industry position when arguing for reimbursement and procedure changes that would be beneficial for centers.
3. CMS proposes to reduce regulatory burdens. In mid-September, CMS proposed a rule that it would said would “… reform Medicare regulations that are identified as unnecessary, obsolete or excessively burdensome on healthcare providers and suppliers.” Key takeaways for ASCs include the following:
4. CMS expands oversight of accreditation organizations. Although technically not a summer announcement, CMS recently announced plans to what it describes as “improve” oversight of those accreditation organizations which have received deeming authority from CMS. The three ways it will do so are described as follows:
These efforts are intended to provide greater transparency to consumers and help accreditation organizations improve their surveying performance. They should also help ASCs gain a better understanding of their accreditation organization choices.
5. KKR acquires Envision. In June, private equity firm KKR & Co. announced it would acquire Envision Healthcare Corp. Envision is a provider of physician-led services and post-acute care, and ambulatory surgery services that was formed in 2016 when a staffing company merged with ASC operator AmSurg.
The acquisition, which was recently completed, seems to indicate sustained interest in ASCs from private equity companies. In 2017, KKR acquired Covenant Surgical Partners and Bain Capital acquired HIG Capital’s stake in Surgery Partners. Physicians Endoscopy has been partially owned by private equity firms for many years. It will be interesting to see what significant private-equity investments come to fruition over the next year.
The results of a recent independent study indicate that fewer adverse events occur following surgery in ambulatory surgery centers (ASCs) than in hospital outpatient departments (HOPDs).
The study was published in the Journal of Health Economics.
Researchers conducted their study using research identifiable file Medicare claims files from 2007–2009. More specifically, they examined ASC and HOPD data based on the 10 most common procedures by 2007 ASC volume, which were broken into six procedure group categories. These procedures represented 68% of claims in the researcher’s data sample.
The procedure group categories were:
Researchers further restricted their analysis to physicians who operated in both ASCs and HOPDs. The analysis then focused on two outcomes as measures of ASC quality: inpatient admissions and ER visits following an outpatient procedure.
Key takeaways from the study’s conclusion included the following:
Access the Journal of Health Economics study here.
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.
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