Study: ASCs Experience Fewer Post-Surgery Adverse Events Than HOPDs

June 22, 2018

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:

  • Cataract removal
  • Colonoscopy
  • Upper GI endoscopy (diagnostic)
  • Biopsy
  • Spine injection
  • Cystoscopy

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:

  • Patients have better health outcomes in terms of inpatient admission and ER visits following an outpatient procedure in ASCs compared to HOPDs.
  • ASCs, on average, provide higher quality care for outpatient procedures than hospitals.
  • The positive impact of ASCs on patient outcomes accrues even to the highest risk group of patients.

Access the Journal of Health Economics study here.

MedPAC Issues ASC Payment Recommendations: 10 Key Takeaways

April 19, 2018

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.

Credential for ASC Infection Preventionists Launched

February 5, 2018

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.

Study: Cataract Surgery Experiences Significant Shift to ASCs

December 13, 2017

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:

  • were younger age;
  • had higher income; and
  • lived in states without certificate-of-need laws.

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.

CMS Issues 2018 ASC Payment Final Rule: 5 Changes to Know About

November 6, 2017

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:

  • ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits within seven days of an orthopedic procedure performed at an ASC (beginning with the 2022 payment determination).
  • ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits occurring within seven days of the urology procedure performed at an ASC (beginning with the 2022 payment determination).

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:

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: ASC Facility Volume Data on Selected Procedures

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.

CMS Grants Quality Reporting Exemptions for ASCs Affected By Harvey and Irma

September 15, 2017

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.

As CMS memos on Harvey and Irma note, ASCs located in these areas will receive an exception for the following reporting requirements under the Ambulatory Surgical Center Quality Reporting Program:

  • Data collection and submission requirements that apply for the remainder of Calendar Year (CY) 2017 and the 2017/2018 Influenza Season that relate to CY 2019 payment determinations. These exemptions apply to all data submitted via the QualityNet Secure Portal and the National Healthcare Safety Network (NHSN) web-based measure collection tools that are due May 15, 2018, including claims-based measures calculated from submitted Quality Data Codes (QDCs). This exemption does not apply to claims-based measures that do not utilize QDCs for calculation purposes.

ASCs located outside of the designated areas may submit ECE requests based on individual circumstances.

Read ASCA’s announcements, which provide additional information and identify FEMA-designated areas, on Harvey here and Irma here.

Ambulatory Surgery Centers Celebrate National ASC Week

August 7, 2017

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.

CMS Issues 2018 ASC Payment Proposed Rule: 5 Things for ASCs to Know About

July 20, 2017

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:

  • ASC-16: Toxic Anterior Segment Syndrome (TASS) measure. This is based on aggregate measure data collected by the ASC via chart abstraction and assesses the number of ophthalmic anterior segment surgery patients diagnosed with TASS within two days of surgery (beginning with the 2021 payment determination).
  • ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits within seven days of an orthopedic procedure performed at an ASC (beginning with the 2022 payment determination).
  • ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures. This assesses all-cause, unplanned hospital visits occurring within seven days of the urology procedure performed at an ASC (beginning with the 2022 payment determination).

CMS is proposing to remove three measures for the 2019 payment determination and subsequent years. The three measures proposed for removal are as follows:

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: ASC Facility Volume Data on Selected Procedures

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.

CDC Updates Surgical Site Infection Guideline

June 20, 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:

  • Prior to surgery, patients should shower or bathe with soap or an antiseptic agent on at least the night before the operative day.
  • Antimicrobial prophylaxis should be administered only when indicated (based on published clinical practice guidelines) and timed so that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made.
  • Skin prep in the operating room should be performed using an alcohol-based agent, unless contraindicated.
  • For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain.
  • Topical antimicrobial agents should not be applied to the surgical incision.
  • During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL.
  • Normothermia should be maintained in all patients.
  • Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation.

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 Provides Guidance on Selecting an ASC

June 12, 2017

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.

Outpatient Healthcare Strategies to Attend ASCA 2017

April 27, 2017

ASCA-2017-Logo_Homepage-Button

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.

To arrange an on-site meeting with a representative of OHS, email info@outpatienthcs.com or contact us.

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.

Surgery Center Consultant Jessica Nantz Discusses Payer Contracting in Becker’s

December 5, 2016

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.

Ambulatory Surgery Center Consultant Arthur E. Casey Discusses Recruitment of Physician Investors

August 16, 2016

ASC logo

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.

ASC Consultant Jessica Nantz Discusses Hybrid ASC Model in Becker’s ASC Review

June 14, 2016

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.

Surgery Center Consultant Jessica Nantz Writes About the Alternative Hybrid ASC Management Model

December 14, 2015

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.

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