Electronic Code of Federal Regulations Updated to Reflect New CMS Policy Regarding Same-Day Surgery

Thanks to ASCA’s efforts this week, the Code of Federal Regulations (CFR) has now been updated to reflect recent CMS policy changes. As of December 23, 2011, ASCs are no longer required to notify patients of their rights, the list of the ASC’s physician investors or the ASC’s advance directive policies prior to the day of surgery. Prior to this week, however, the CFR was not updated to reflect this change, and so the online regulations incorrectly stated that an ASC had to provide patients a copy of the center’s advance directive policy prior to surgery. Concerned that this error may lead to surveyor misinterpretation, ASCA reached out to the Government Printing Office which acknowledged the oversight and updated the online copy of the regulations.   Unfortunately, the interpretive guidelines used by state Medicare surveyors have not yet been revised to reflect this change. As a consequence, state Medicare surveyors who rely solely on the interpretive guidelines may still incorrectly cite an ASC for non-compliance when it does not notify patients of the required information prior to the date of surgery. ASCA is working with CMS to ensure the guidelines are updated soon. ASCs that experience survey issues can point surveyors to the actual regulations, available online, as well as ASCA’s memo explaining the change.   For more information, contact Jonathan Beal at jbeal@ascassociation.org.

Representative John Barrow Visits Savannah ASC

This past week, U.S. Representative John Barrow (D-GA) visited Midtown Surgical Center in Savannah, GA to see first-hand the superior surgical care his constituents have been receiving. The visit stemmed from the 2011 fly-in by Georgia members when John Murrell, MD personally invited the congressman to tour his ASC facility.

 

Pictured above from left to right: Tiffany Murrell-Roberts Billing Coordinator,  Martha Anne Wilson-Front Office Coordinator, Michelle Reaves, RN- Clinical Nurse Manager, Congressman John Barrow, Dr. John Murrell-Owner, and Teresa Murrell- Practice Manager-Owner

During the tour, the congressman learned from Dr. Murrell and Clinical Nurse Manager Michelle Reaves about the day-to-day operations of the ASC, including the patient cycle of care and ASC finances. Dr. Murrell and Rep. Barrow discussed the many benefits ASCs provide the health care system and the challenges many ASCs must battle. According to Dr. Murrell, Rep. Barrow was aware of the Ambulatory Surgical Center Quality and Access Act legislation and is supportive of the ASC industry.   Following the tour, Dr. Murrell and Rep. Barrow discussed Medicaid reimbursement and improving health care for indigent patients, an issue of importance to both of them. Dr. Murrell was invited to participate in Rep. Barrow’s annual health care fair.   For more information regarding the visit or how to host your own, contact Morgan Hanson at mhanson@ascassociation.org.

 

Wisconsin Legislation to Eliminate Assessment on ASCs Passes Key Committee

An effort to eliminate the assessment on ambulatory surgical centers (ASCs) in Wisconsin took an important step forward this week, as Wisconsin SB 297  was voted out of the Senate Committee on Public Health, Human Services, and Revenue. Under current law, the Department of Revenue (DOR) may impose an assessment on ASCs in proportion to their gross patient revenue. ASCs would no longer be subject to such an assessment if this legislation is enacted.   The bill, which is supported by the Association of Wisconsin Surgery Centers (WISCA), passed out of committee by a 5-0 vote. Eric Ostermann, WISCA executive director, stated he was “excited for the bipartisan support.” Mr. Ostermann added that the association will “continue to work hard to keep moving this through the legislature.” In addition to WISCA, the legislation is also supported by the Wisconsin Medical Society. The bill now moves to the full Senate, and would have to go through the same process in the Assembly. If enacted, it would become effective July 1, 2013.   For more information, contact Kara Marshall at kmarshall@ascassociation.org.

ASCA Takes Steps to Clarify Conditions for Coverage Misunderstanding

A delay by the Centers for Medicare & Medicaid Services (CMS) in updating the interpretative guidelines that are used by state Medicare surveyors has created problems for several ASCs during their surveys.  As of December 23, 2011, based on a rule change announced last fall, ASCs can now notify patients of their rights, the ASC’s advance directive policies and the list of the ASC’s physician investors on the day of surgery.  The interpretive guidelines used by state Medicare surveyors, however, have not been revised to reflect this change and are, therefore, out of date.  As a result, state Medicare surveyors who rely solely on the interpretive guidelines have incorrectly cited ASCs for noncompliance when those ASCs did not notify patients of the required information prior to the date of surgery. ASCA has contacted CMS regarding this issue and requested its help in assuring that surveyors are informed of the change and that the interpretive guidelines are updated as soon as possible.  A memo explaining the change is available here. This document can be used by ASCs if they encounter a state Medicare surveyor who is unaware of the change in the notification requirements.  ASCA members that experience survey problems with this or other issues should contact Jonathan Beal at jbeal@acsassociation.org.

2012 National Capitol Fly-In Dates Announced

This year, the Ambulatory Surgery Center Association (ASCA) will be hosting two National Capitol Fly-In events. One will be held on April 18-19 and the other June 19-20. Eight states—Texas, California, Florida, Tennessee, Arizona, Massachusetts, New Hampshire and Ohio—have already committed to participating. Several other states, including Oklahoma, Kansas and Georgia have also expressed interest in visiting their legislators on Capitol Hill. More than 80 percent of the cosponsors for the Ambulatory Surgical Center Quality and Access Act of 2011 signed on last year thanks to grassroots advocacy efforts by ASCA members who took the extra step of reaching out to their elected officials.  Help build on last year’s successes and strengthen the support for the ASC community from Congress. Encourage ASC professionals in your state to become politically active and to talk with their elected and appointed officials about ASCs.  For more information on how to get involved in the 2012 National Capitol Fly-In program or in other ways, contact Morgan Hanson at mhanson@ascassociation.org.

Two New Committees Formed at ASCA

The ASCA Board of Directors has approved the formation of two new committees within the Government Affairs Department and set them to begin operations on January 1 this year.  The first committee is the State Affairs Committee, which is charged with “fostering better communication and coordination between ASCA and the state associations, in order to facilitate information sharing and eliminate duplication of effort.” An initial task of the committee will be surveying state association contacts regarding current programs and potential new programs to help fulfill the committee’s charge. The committee consists of nine state association leaders in seven different geographic regions, and one member who will represent ASCA’s corporate members. The committee is comprised of the following:    Carol Blanar, RN BS CNOR Executive Director, Indiana Federation of Ambulatory Surgery Centers Bobby Hillert Executive Director, Texas Ambulatory Surgery Center Society Craig Jeffries Corporate Representative on behalf of corporate members Nueterra Healthcare and AmSurg Corporation Beth LaBouyer Executive Director, California Ambulatory Surgery Association Randy Leffler Executive Director, Ohio Association of Ambulatory Surgery Centers Peter Lohrengel (Chair) Executive Director, Florida, Georgia, Mississippi, South Carolina and Tennessee state associations Mark Mayo Executive Director, Ambulatory Surgery Center Association of Illinois Joyce Meisel, BSN RN CASC President, New Hampshire Ambulatory Surgery Association Sheri Sass Administrator, Idaho Ambulatory Surgery Center Association   Robert Schwartz Executive Director, Colorado, Oregon and Washington state associations     The second committee is the Government Affairs Committee, which is charged with overseeing the operations of the Government Affairs Department.  Among the items that the committee has been tasked with are the establishment of a legislative and government affairs agenda for ASCA and the development of a policy-making process for legislative and regulatory issues.  The committee is comprised of the following 12 members:   Jesseye Arrambide, RN BSN CNOR Executive Director, Oregon Outpatient Surgery Center   David Ayers Chief Executive Officer, Nueterra Healthcare   Jo Ellen Braden, RN CASC Administrator, Marysville Ohio Surgical Center, LLC   Dave Fitzgerald Chief Executive Officer, Proliance Surgeons, Inc   Richard Francis, Jr. Chairman & Chief Executive Officer, Symbion, Inc   Andrew Hayek President & Chief Executive Officer, Surgical Care Affiliates   Chris Holden President, Chief Executive Officer & Director, AmSurg Corporation   Sarah Martin, MBA RN CASC Regional Vice President of Operations, Meridian Surgical Partners   Keith Metz, MD (Chair) Medical Director, Great Lakes Surgical Center, LLC   David Shapiro, MD CASC Partner, Ambulatory Surgery Company, LLC   Jill Sluder, RN CASC Administrator, Summit Ambulatory Surgery Center   Bill Wilcox Chief Executive Officer, United Surgical Partners International   For more information, please contact Steve Miller at smiller@ascassociation.org.

New Jersey Governor Vetoes One-Room Surgical Practices Licensure Legislation

Earlier this week, Governor Chris Christie pocket-vetoed legislation that would have required surgical practices with only one operating room (OR) to be licensed by the New Jersey Department of Health and Senior Services (DHSS). A pocket veto applies only to bills passed within the last 10 days of a two-year legislative session, and is the only type of veto in which the Governor does not return the bill to the legislature for a possible override vote. Hospitals and multiple-OR surgery centers have been under the purview of the DHSS, but the State Board of Medical Examiners currently oversees one-OR surgical practices. Throughout the legislative process, DHSS voiced concerns about the financial burden that would be created by requiring the department to also license and inspect one OR surgical practices. The New Jersey legislature had passed SB 2780 (AB 4099) by a substantial majority last week. The legislation was supported by the New Jersey Association of Ambulatory Surgery Centers (NJAASC), the New Jersey Hospital Association and the Medical Society of New Jersey. Jeffrey Shanton, chair of the Advocacy & Legislative Affairs Committee for NJAASC, stated that “to say I’m disappointed would be an understatement.” He confirmed, however, that the association will continue to work hard to pass legislation regarding one-OR facilities. “The NJAASC will sit down with [DHSS] Commissioner Conroy and try to iron out the issues. We continue to believe that this legislation is imperative for the industry, and most importantly for the patients.” Governor Christie did, however, sign SB 1988 (AB 3646), which phases out the state's cosmetic medical procedure gross receipts tax. Currently, consumers of cosmetic procedures are charged a 6 percent tax on the gross receipts from any cosmetic medical procedure they receive. This legislation will reduce the tax each year until July 1, 2014, when cosmetic medical procedure patients will no longer be charged a gross receipts tax. The first reduction will occur in July 2012, when the tax rate will be reduced to 4 percent. For more information, contact Kara Marshall at kmarshall@ascassociation.org.

CMS Advises ASCs to Resubmit Recently Paid Medicare Claims if Incorrect

The Centers for Medicare & Medicaid Services (CMS) has indicated to ASCA that recent payments to ASCs may not have reflected Congress’s December 23rd vote to delay a potential reduction in physician payments due to the flawed sustainable growth rate (SGR) formula. The payments CMS issued may also not have accounted for the agency’s correction of technical errors in determining payment rates. CMS recommends that ASCs that believe they have not been accurately reimbursed should resubmit those claims.   For more information on the SGR and the recently corrected Medicare payment rates, see the January 5th issue of ASCA’s Government Affairs Update.  A list of the ASC procedures affected by changes in the physician rates is available here.   ASCA’s rate calculator, available on the ASCA web site,  has been updated to reflect the revised rates. A comparison between the revised 2012 rates and those released this past November is available here.   For more information, contact Jonathan Beal at jbeal@ascassociation.org.

Medicare's 2012 Rates Corrected

CMS has corrected the 2012 ASC payment rates that the agency published in November. The corrections address technical errors in how the costs of certain procedures were determined. The effect of these corrections on the 2012 rates is, for the most part, not substantial. The payment rates for some procedures have changed significantly, however. A comparison is available here. ASCA's rate calculator has been updated to reflect the revisions. A copy of the notice announcing the change is available here.    For more information, contact Jonathan Beal at jbeal@ascassociation.org.

New Medicare Remittance Process Established

The Department of Health & Human Services (HHS) has finalized a requirement for HIPAA-covered health plans to send an advice notice to a health care provider who is paid electronically with a trace number that will facilitate reconciliation between a provider’s bill and the corresponding payment from a health plan.  The new requirement is expected to streamline the processing of electronic claims and lead to more efficient administration of health care delivery. The requirement becomes effective January 1, 2014. HHS’s press release is available here and the final rule here.   For more information, contact Jonathan Beal at jbeal@ascassociation.org.

Major Victories for ASCs in New Jersey

New Licensure Requirement for One-Room Surgical Practices: The New Jersey Legislature on Monday approved SB 2780 (AB 4099), which requires surgical practices with only one operating room (OR) to be licensed by the New Jersey Department of Health and Senior Services (DHSS). Hospitals and multiple-OR surgery centers are already under the purview of the DHSS, but the State Board of Medical Examiners currently oversees one-OR surgical practices. The legislation is expected to be signed by Governor Chris Christie and it would require one-OR surgical practices to obtain a license from DHSS within one year of the bill being signed. The legislation was supported by the New Jersey Association of Ambulatory Surgery Centers (NJAASC), the New Jersey Hospital Association and the Medical Society of New Jersey. Jeffrey Shanton, chair of the Advocacy & Legislative Affairs Committee for NJAASC, praised the bill’s sponsors, Senator Joseph Vitale and Assemblyman Herb Conaway, Jr., “for their tireless efforts in helping to formulate and pass this legislation.” He went on to add that, “this legislation creates a level playing field by holding all centers to the same standards. It is one of the most important pieces of legislation concerning the ASC industry in New Jersey in years, especially as it benefits the patients, who can now rest assured that they will be receiving the same safe, high-quality care wherever they go."   Phase Out of Gross Receipts Tax on Cosmetic Medical Procedures: The New Jersey Legislature also passed a bill Monday AB 3646 (SB 1988) that will phase out the state's cosmetic medical procedure gross receipts tax. Currently, consumers of cosmetic procedures are charged a 6 percent tax on the gross receipts from any cosmetic medical procedure they receive. This legislation will reduce the tax over the next three years, so that by July 1, 2014, cosmetic medical procedure patients will no longer be charged a gross receipts tax. The legislation must be signed by Governor Christie before it becomes law.   For more information, contact Kara Marshall at kmarshall@ascassociation.org.

Third Quarter 2011 Quality Data Now Available from the ASC Quality Collaboration

ASC quality data for the third quarter of 2011 (July 1–September 30, 2011) is now available on the ASC Quality Collaboration’s web site. Comparisons to performance data for the three quarters preceding the 2011 third quarter report are also available there. A total of 1,314 ASCs, including 855 multi-specialty and 459 single-specialty facilities, contributed data to the quality reports. The reporting facilities represent every state except Vermont. The report includes aggregated performance data for the six ASC facility-level quality measures that follow: • patient fall in the ASC • patient burn • hospital transfer/admission • wrong site, side, patient, procedure, implant • prophylactic IV antibiotic timing • appropriate surgical site hair removal All six measures were developed by the ASC Quality Collaboration and, subsequently, endorsed by the National Quality Forum. Organizations that collected and submitted the clinical quality data included in the ASC Quality Collaboration’s third quarter 2011 report include the Ambulatory Surgery Center Association; Ambulatory Surgical Centers of America (ASCOA); AmSurg; Healthcare Facilities Accreditation Program (HFAP); Health Inventures; HCA Ambulatory Surgery Division; Nueterra; Surgical Care Affiliates (SCA); Symbion and United Surgical Partners International (USPI). For more information, contact ASC Quality Collaboration Executive Director Donna Slosburg at donnaslosburg@ascquality.org.

MedPAC Finalizes ASC Recommendations

Today the Medicare Payment Advisory Commission (MedPAC) voted to recommend that ASCs receive a 0.5 percent increase in payment rates for 2013. MedPAC is an independent congressional agency charged with advising Congress and the US Department of Health and Human Services (HHS) on Medicare payment policies, patient access and quality of care. The commission also voted to recommend that ASCs be directed to report cost data and that Congress should provide the HHS with the authority to implement a value-based purchasing (VBP) program for ASCs. These recommendations are not binding on Congress. The commission voted to recommend a 1 percent increase in payment rates for hospitals in 2013. Commission staff noted that the lack of cost data from ASCs precluded them from recommending an update similar to the hospitals. ASCA Executive Director William Prentice noted, “MedPAC's recommendations would continue the growing disparity between ASC and HOPD payments that exist today. This will continue to jeopardize the savings that ASCs offer the Medicare program and its beneficiaries.” For more information, contact Steve Miller at smiller@ascassociation.org.

Congress Delays SGR Cuts

On December 23rd, physicians received a brief reprieve from a 27 percent Medicare pay cut that was due to take affect starting January 1st thanks to the passage of legislation that also included an extension of the payroll tax cut and unemployment benefits for the long-term unemployed. Under the agreement, the House and Senate decided to extend the current Medicare payment rates for two months while a House/Senate conference committee convenes this month to work on a longer-term agreement on these issues. The potential physician payment cut is triggered by the Medicare Sustainable Growth Rate (SGR), which is the method the Centers for Medicare & Medicaid Services (CMS) uses to update physician payments. The SGR was enacted by Congress in 1997 as a way to control Medicare spending on physician services. Since then, the SGR has caused 11 potential reductions in payments. Congress passed legislation to avert the cuts each year except 2002; unfortunately, each time the cuts are deferred, the underlying cost of “fixing” the SGR increases. The current “fix” is projected to cost more than $300 billion. The postponement of the physician rate cut affects the 2012 ASC facility payment rate for procedures that are paid for at the physician-office payment rate. Beginning January 1, ASCs will see payments for these procedures that are higher than the rates CMS released this past fall. ASCA's rate calculator has been updated to reflect this change. If Congress does not act again to delay the physician cuts, ASCs will face a reduction in these procedure payment rates beginning in March. Congress has until February 29th to reach an agreement on a longer term package. ASCA will work along side the physician community to find a long-term solution to the yearly specter of devastating SGR cuts. For more information, please contact Steve Miller at smiller@ascassociation.org.

Medicare's 2012 Rates Corrected

CMS has corrected the 2012 ASC payment rates that the agency published in November. The corrections address technical errors in how the costs of certain procedures were determined. The effect of these corrections on the 2012 rates is, for the most part, not substantial. The payment rates for some procedures have changed significantly, however. A comparison is available here. ASCA's rate calculator has been updated to reflect the revisions. A copy of the notice announcing the change is available here.    For more information, contact Jonathan Beal at jbeal@ascassociation.org.

ASCA Comments on Medicare's Proposed Changes to the ASC Emergency Equipment List

ASCA submitted a letter to CMS that supports the agency’s proposal to replace the current, unnecessarily prescriptive list of emergency equipment that an ASC must have on hand with the more sensible decision to, as CMS’s proposal puts it, allow an “ASC, in conjunction with its governing body and the medical staff, to develop policies and procedures that specify the types of emergency equipment that would be appropriate for the facility's patient population.” ASCA's letter notes that, "by empowering an ASC’s governing body and medical staff to establish a list of the emergency equipment that best suits the needs of the patients the ASC serves, CMS will assure that each ASC has the most appropriate and up-to-date emergency equipment on hand. This change will also remove the burden and cost of maintaining unnecessary equipment.” A copy of the letter is available at here.    For more information, contact Jonathan Beal at jbeal@ascassociation.org.

Stats in the States

The following statistics provide a glimpse of the scope of legislative issues ASCs faced at the state level over the past year and a glimpse of those to come. 2011 Wrap-Up 347: Number of ASC-relevant state bills ASCA tracked in 2011. 83: Pieces of ASC-relevant legislation that addressed quality assurance and data reporting. Of these 83 bills, 17 were enacted, including Hawaii legislation that addresses health care-associated infection (HAI) data reporting. HB 889 allows the Hawaii Department of Health to access health care acquired infections data that all Medicare-certified health care facilities are required to report to the Centers for Disease Control and Prevention’s national health care safety network.  42: ASC-relevant bills enacted in 2011.   2012 Preview 16: Number of jurisdictions (15 states and the District of Columbia) currently in session. 18: Number of states scheduled to convene next week. 243: ASC-relevant bills already introduced or pre-filed for 2012. One bill to watch during the 2012 session is New Hampshire HB 1617, which would repeal the certificate of need law in that state if the bill is enacted as currently drafted. For more information on either ASC issues in a specific state or a piece of state legislation, please contact Kara Marshall at kmarshall@ascassociation.org.

2011 Government Affairs Wrap Up

As 2011 comes to a close, we are pleased to reflect on the many advocacy successes that we have been able to achieve this year by working together to protect and preserve the ASC delivery model. While many challenges remain, we want to thank all of our grassroots and political action supporters for their efforts this year, and we look forward to working with you in 2012 and beyond. As you can see from the following highlights, we have generated significant positive momentum and it is essential that we keep it going next year.     Regulatory Accomplishments    CMS Repeals Same Day Surgery Provision – Persistent pressure from ASCA, and our congressional supporters, led to CMS removing the restriction on ASCs providing same-day surgery for patients, allowing ASCs to provide timely health care to patients.   ASCs Receive Higher than Expected Reimbursement Update – CMS took notice of the ASC industry’s concerns regarding their proposed 2012 Payment Rule and increased the ASC reimbursement update from 0.9% to 1.6%.   ASC Industry Works With CMS to Postpone Quality Reporting – After vigorous objection to the start date for the CMS proposed Quality Reporting Program from ASCA and its members, CMS postponed the mandatory Quality Reporting start date from January 1, 2012 to October 1, 2012.    Small Business Paperwork Elimination Act – ASCA, in conjunction with allied groups, helped to pass legislation repealing a provision of the Health Care Reform Law that would have required ASCs to file a 1099 form for every vendor they work with. This repeal halted additional paperwork requirements on already overburdened ASCs.     Legislative and Grassroots Accomplishments   ASC Quality and Access Act of 2011 (H.R. 2108/S. 1173) Introduced – ASCA worked with key members of Congress to introduce the ASC Quality and Access Act of 2011. The legislation has garnered 38 supporters in the House of Representatives and five supporters in the Senate.   12 State ASC Delegations Travel to Washington, DC to Lobby Their Members of Congress – ASCA hosted 12 individual state delegations in Washington, DC during 2011. This resulted in over 100 individual meetings allowing members of the ASC community to educate their members of Congress and congressional staffs on the industry and seek cosponsorship of the ASC Quality and Access Act.   Growing Grassroots Involvement by ASCs – Thirty ASCs stepped up their involvement and/or became involved for the first time by hosting their member of Congress or other elected officials at their facility for a tour and to educate them about the industry. Several of these visits resulted in the member of Congress becoming a cosponsor of the ASC Quality and Access Act of 2011.    ASCs Complete Another Successful National ASC Open House Day – Three times as many ASCs across the country opened their doors this year to educate their communities, elected officials and the media about the high quality care available in local ASCs. Many ASCs had local, state and federal legislators attend.   For more information, contact Brendan Davis at bdavis@ascassociation.org.

Physicians Still Face 27% Cut

With the congressional clock for the year close to expiring, physicians still face a 27% cut in Medicare payments that are scheduled to take effect January 1, 2012. Congress must pass legislation adjusting the Sustained Growth Rate (SGR) formula before the end of the year to stave off these devastating reductions. It is well past time for Congress to adopt a long-term solution to the SGR formula and move to a more stable Medicare physician payment system that provides security for both patients and the physicians who care for them.   To voice your concern on this critical issue, email your legislators today and tell them that now is the time to repeal the flawed SGR formula! For more information, contact Morgan Hanson at mhanson@ascassociation.org.

 CMS Releases Final ASC Payment Rule

 

On October 31, 2012, the Centers for Medicare & Medicaid Services (CMS) finalized its 2012 ASC payment policies. ASCs will see an increase of 1.6% across the board, a 0.7% increase over what had been proposed this summer. CMS has added six new procedures to the list of ASC payable procedures for 2012. ASCs will be required to report data on five quality measures beginning October 1, 2012, or face reductions in their 2014 Medicare payments.

  

Quality Reporting

This summer, CMS had proposed requiring ASCs to report data on seven quality measures beginning January 1, 2012. The agency, however, listened to the objections from the ASC community and will delay quality reporting until October 1, 2012. Additionally, CMS removed two measures, appropriate hair removal and antibiotic selection, from the measures that ASCs will be required to report. CMS indicated that they will evaluate the list of reportable measures annually, adding new measures and retiring other measures as needed. Below is a list of finalized measures, the reporting period and the payments affected.

 

To download the section of the CMS payment rule related to the ASC Quality Measure reporting, click here.  

  

Finalized Measures

 

The first five measures will be reported beginning October 1, 2012 using a claims based system.

 

Measure	Reporting Period	Payments Affected
1. Patient Burn	Begins October 1, 2012	2014
2. Patient Fall	Begins October 1, 2012	2014
3. Wrong Site, Side, Patient, Procedure, Implant	Begins October 1, 2012	2014
4. Hospital Admission/Transfer	Begins October 1, 2012	2014
5. Prophylactic IV Antibiotic Timing	Begins October 1, 2012	2014

 

CMS will require ASCs to collect data on the following measures beginning January 1, 2012. However, the data will not be reported until a later period.

 

Measure	Reporting Period	Payments Affected
6. Safe Surgery Check List Use in 2012	July 1 thru August 15, 2013	2015
7. 2012 Volume of Certain Procedures	July 1 thru August 15, 2013	2015

 

More information will be provided at a later date on the collection and reporting of the final measure related to influenza vaccination for health care workers.

 

Measure	Reporting Period	Payments Affected
8. Influenza Vaccination Coverage Among Health Care Workers	October 1, 2014 thru March 31, 2015	2016

 

 

ASCs will be required to use different methods to report the required information. The first five measures will be reported by using codes added to claims, while the safe surgery check list and the surgery volume measures will be reported via the internet and the influenza vaccination measure will be collected via the CDC's National Health Safety Network. ASCs that fail to report data on the five quality measures will have their 2014 rates reduced by 2.0%.

  

Rate Changes

The rates that a given ASC will be paid in 2012 will depend upon several factors, including a 1.6% across-the-board increase, changes in the estimated cost of providing the procedure and changes in the ASC wage index. You can see what your ASC will be paid in 2012 by using ASCA's rate calculator.

  

?ASC Procedures List Changes

Beginning January 1, 2012, Medicare will pay ASCs for six additional procedures.

 

These procedures are

  

HCPCS Code	Description	2012 National ASC Rate
37201	Transcatheter therapy infuse	$661.15
37202	Transcatheter therapy infuse	$661.15
37207	Transcath iv stent open	$4,660.56
37208	Transcath iv stent/open addl	$4,660.56
59074	Fetal fluid drainage w/us	$140.49
G0365	Vessel mapping hemo access	$87.48

 

Additionally, certain codes have been deleted from the ASC list and replaced by other codes. To view the complete list of codes that have been added, click here.  

 

For additional resources, go to the ASC Association's website at

http://ascassociation.org/medicare2012/.

 

On October 18th, the Centers for Medicare & Medicaid Services (CMS) released a final rule that removes its limitation on ASCs performing procedures on the day they are scheduled. ASCs will now be allowed to provide patient notifications on the day the procedure is performed, clearing the way for same-day surgeries.
 

The rule: 

• Removes the requirement that the notice of patient rights must be provided "in advance of the date of the procedure" and replaces it with the requirement that the notice must be provided "prior to the start of the surgical procedure."  This will allow ASCs to determine when they will provide these notices for all their patients as long as they are done prior to the surgical procedure being done. Particularly amends 416.50(a)(1) and other conditions.

• Removes the language of the previous exemption on this subject that provided for "emergency" notices being given on the day of surgery and outlining certain requirements that have to be met for the patient to qualify under the emergency criteria. Amends 416.50(h).

• Revises 416.50(d)(6) to add the patient's representative or the patient's surrogate to the parities that may be given written notice of a grievance decision.

 

This revision will take effect on December 23, 2011.

 

To download the complete rule change, click below.

Supporting Documents: CMS Same Day Rule PDF

Updated Version of CMS Guidance for Surveyors: ASCs Released

 

CMS has published a new version of the State Operations Manual Appendix L – Guidance for Surveyors: Ambulatory Surgical Centers, which was updated May 13, 2011.

 

The changes are based on the Survey and Certification Memo issued December 17, 2010, titled “Clarifications to the ASC Interpretive Guidelines – Comprehensive Medical History & Physical (H&P) Assessment.” Among other revisions, a comprehensive H&P and surgery may now be performed on the same day.  

 

Please review the changes in the interpretive guidelines for 416.42(a)(1) (pages 59-60) and 416.52(a)(1) and (2) (pages 157, 158 and 160).

 

For your reference, the document is being provided with page numbers included.

Supporting Documents: State Operations Manual - Appendix L ASCs 5-13-11

CMS has released a memo clarifying the use of same day H&P assessments.  Below is a summary of the memo.

 

·           Comprehensive H&P and Surgery may be performed on same day: As long as the H&P is performed by qualified personnel, is comprehensive, and is placed in the patient’s ASC medical record prior to surgery, it may be performed on the same day as the surgical procedure, including in the ASC.

 

·           Comprehensive H&P and some elements of the pre-surgical assessments may be conducted as one assessment: If the H&P is conducted in the ASC on the same day as the surgical procedure, then some elements of the required pre-surgical assessments may be incorporated into the H&P.

 

Click the link below to view the complete memo from CMS.

Supporting Documents: CMS H&P Memo