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New Video Available – RETINA in the ASC
NOW AVAILABLE - RETINA in the ASC
The collaborative efforts of OOSS and Alcon® Retina are pleased to provide you four video interviews on Retina in the ASC. These interviews were conducted during the 2011 American Academy of Ophthalmology in Orlando, Florida. In this series, Michael Romansky, JD, (OOSS Washington Counsel & VP Corporate Development) updates you on the latest changes in both the legislative and regulatory arenas, Pravin Dugel, MD, (Retinal Consultants of AZ, Sun City, AZ) provides his perspective on New Parameters for Surgical Efficiency, Mary Cantu (Manager – US Reimbursement, Alcon Laboratories, Fort Worth, TX) has a US Reimbursement Update and Mr. Steve Sheppard (Managing Principal – Medical Consulting Group, Springfield, MO) discusses the Financial Implications of an ASC. We believe these short videos will yield a better understanding of Retina surgery in an Ambulatory Surgery Center.
COMPILATION OF KEY ASC QUALITY REPORTING RESOURCES NOW AVAILABLE
As OOSS members are well aware, commencing January 1, 2012, the Centers for Medicare and Medicaid Services is launching an ASC Quality Reporting (QR) Program with respect to which all Medicare ASCs will be required to report data or be subject to penalties. Over the past few weeks, the agency and organizations with whom OOSS is affiliated have released regulations, transmittals, manuals, and other materials designed to provide ASCs with information that will promote compliance with the requirements of the new QR program. This Update Online is the first of an ongoing series to provide you with a consolidated library of these resources. We are not planning on providing you with everything that is published on the subject, but rather, that which we think will best enable you to comply with the new program.
In developing and disseminating these materials, we are working in close collaboration with, and are grateful for the tremendous contributions of, the ASC Association (which represents the broader community of surgery centers) and the ASC Quality Collaboration (on whose Board OOSS sits), which develops quality measures, reports quality data, and develops tools for improved quality in ASCs.
THE PROPOSED GUIDELINES
On April 26, CMS released proposed guidelines for the new QR program. These can be reviewed at: Click Here
OOSS will submit comments on behalf of the ophthalmic ASC community to CMS regarding these guidelines. Among the highlights:
- The use of quality data codes on an ASC’s claims will indicate that a facility is participating in the QR program; the facility does not need to separately provide notice to CMS.
- Any ASC that is a Medicare-participating facility as of January 1, 2012 will need to begin reporting October 1, 2012 to be eligible for full Medicare updates in 2014.
- The proposal establishes a completeness threshold of 50%, which means that ASCs will be considered successful reporters and not subject to penalties if 50% of their claims contain quality data codes.The threshold will increase in the future.
- CMS will not seek to validate what ASCs report through record review or any other means beyond the usual Medicare contractor processes.
- ASCs will have access to the same reconsideration process available to hospitals in order to challenge CMS rulings as failure to adequately report data.
- An extension/waiver process will be available to ASCs that are unable to report quality data due to extraordinary circumstances.
- While CMS continues to state that “any and all” data could be made public, the agency has still not specified what data will use for public reporting.
- Facilities will be required to designate an individual to serve as the Center’s QualityNet administrator, the person who will serve as point of contact between the facility and the Quality/Net website. ASCs will use this website to report data on their use a safe surgery checklist (2012) and the surgical volume they manage beginning in the summer of 2013, at which time the administrator will have to be in place.
THE QUALITY MEASURES SPECIFICATIONS MANUAL
On April 30, CMS released its Quality Measures Specification Manual. Click Here
This manual provides detailed information regarding how ASCs should report information to CMS. Some of the highlights include:
- As a result of the advocacy efforts of OOSS in collaboration with the ASC Association, AAO, ASCRS and other interested groups, ophthalmic ASCs will be required to report on four (of five) claims-based measures during the reporting period October 1 through December 31, 2012 in order to avoid a 2% update in payments in 2014. These measures requiring reporting: Patient Burn; Patient Fall; Wrong Site, Side, Patient, Procedure, Implant; Hospital Admission/Transfer. Routine reporting on the measure Prophylactic IV Antibiotic Timing will not be required.
- When patients do not experience any of the adverse events encompassed by the four applicable measures, the ASC may report with a single g-code (G8907) rather than having to report on each measure separately.
- CMS has made a significant change in implementation of the requirement that facilities use a safe surgery checklist in 2012. Originally, ASCs would have been required to certify that such a checklist was in place on January 1, 2012. The Manual clarifies that ASCs using a safe surgery checklist at any time during 2012 can answer “yes” when reporting its use of the checklist to CMS.
The ASC Quality Collaboration has also issued a companion manual, ASC Quality Measures: Implementation Guide. This includes excellent frequently-asked-questions with respect to the application of each quality measure to our facilities. The Implementation Guide can be reviewed at: Click Here
ASC QUALITY REPORTING PROGRAM: OTHER RESOURCES
OOSS Update Online — CMS ASC Quality Reporting G-Codes: Facilities Must Report in October, May Start Reporting in April.
OOSS will do everything possible to facilitate our members’ understanding and ability to comply with these regulations. This compendium of resources will be constantly updated. We will continue to provide guidance as CMS provides the ASC community with further information. To this end, OOSS is planning at least one free webinar for ophthalmic ASCs, designed to help you ready your facility for the new quality reporting program. Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.
CMS ISSUES CLARIFICATION THAT NOTICE OF PATIENT RIGHTS MAY BE PROVIDED IMMEDIATELY PRIOR TO SURGERY
As you know, OOSS was integrally involved in the reversal of CMS’ misguided policy that required ASCs to provide notice to patients of their rights at least one day prior to surgery, effectively denying the patient the option of having surgery on the same day as diagnosis. The agency released on March 30 a letter clarifying that the ASC:
· Is no longer required to provide notice of patient rights in advance of the date of the procedure. Provision of notice on the same day as, but prior to the start of, the surgical procedure is acceptable.
· Must provide notice of patient rights to the patient, the patient’s representative, or the patient’s surrogate. The prior rule made no mention of a surrogate.
· Must disclose, in writing, physician financial interest or ownership in the ASC, and, where applicable, provide a list of physicians who have financial interest or ownership in the ASC facility.
The interpretive guidelines used by surveyors to conduct surveys will soon be updated to include these changes.
This rule became effective on December 23, 2011. However, because CMS did not send specific instructions to Medicare surveyors regarding the change, many facilities have encountered problems with inspectors applying the prior requirement, i.e., that notice be provided at least one day prior to surgery.
Should you have any questions, please contact OOSS’ Washington Counsel, Michael Romansky, at mromansky@OOSS.org.
The CMS letter may be reviewed by clicking here.
CMS RELEASES ASC QUALITY REPORTING G-CODES: FACILITIES MUST REPORT IN OCTOBER, MAY START REPORTING IN APRIL
CMS RELEASES ASC QUALITY REPORTING G-CODES: FACILITIES MUST REPORT IN OCTOBER, MAY START REPORTING IN APRIL
Earlier this week, CMS issued Carrier Manual Instruction 2425, which includes the list of G-Codes to be used to reflect compliance with the new Medicare ASC quality reporting program on Medicare claims commencing October 1, 2012. Failure to include these codes on claims will result in reductions in future payments starting in 2014. ASCs may begin using these codes on a voluntary basis commencing April 1, 2012.
The measures, G-codes, and descriptions are as follows:
| Quality Measure | G-code | Description | |||
| All | G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility. | |||
| Patient burn | G8908 | Patient documented to have received a burn prior to discharge | |||
| Patient burn | G8909 | Patient documented not to have received a burn prior to discharge | |||
| Patient fall in ASC facility | G8910 | Patient documented to have experienced a fall within ASC | |||
| Patient fall in ASC facility | G8911 | Patient documented not to have experienced a fall within Ambulatory Surgical Center | |||
| Wrong site, wrong side, wrong patient, wrong procedure, wrong implant | G8912 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | |||
| Wrong site, wrong side, wrong patient, wrong procedure, wrong implant | G8913 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event | |||
| Hospital transfer/Admission | G8914 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC | |||
| Hospital transfer/Admission | G8915 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC | |||
| Timing of Prophylactic Antibiotic Administration | G8916 | Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time | |||
| Timing of Prophylactic Antibiotic Administration | G8917 | Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time | |||
| Timing of Prophylactic Antibiotic Administration | G8918 | Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis | |||
Should you have any questions, please contact OOSS’ Washington Counsel, Michael Romansky, at mromansky@OOSS.org.
A copy of the Medicare transmittal can be reviewed by clicking here.
HHS INSPECTOR GENERAL TO STUDY ASC PAYMENT RATES AND COMPARE HOSPITAL AND ASC SAFETY AND QUALITY
HHS INSPECTOR GENERAL TO STUDY ASC PAYMENT RATES AND COMPARE HOSPITAL AND ASC SAFETY AND QUALITY
On October 5, the Office of the Inspector General, HHS (OIG) released its 2012 Work Plan, which includes the conduct of two studies of interest to the ASC community:
· Ambulatory Surgical Centers: Payment System (2012). The OIG will “review the appropriateness of Medicare’s methodology for setting ambulatory surgical center payment rates under the revised payment system.” OOSS and the ASC community will certainly raise with the agency our ongoing concerns regarding the growing disparity in payment rates to ASCs and hospital outpatient departments — caused by the arbitrary application of budget neutrality adjustments and inadequately low annual update factor to ASC reimbursements.
· Ambulatory Surgical Centers and Hospital Outpatient Departments (HOPD): Safety and Quality of Surgery and Procedures (2012-3). The agency will review the safety and quality of care provided Medicare beneficiaries in both settings. In conducting this study, the OIG will: assess care in preparation for and provided during surgeries and procedures in both settings; identify adverse events; and, compare quality and safety between the settings.
As noted above, OOSS will meet with the OIG, offer our organization as a resource to the agency, and present evidence and our views regarding ASC payment and safety and quality, and made appropriate recommendations. We will keep you abreast of further developments. Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.
The entire OIG Work Plan can be reviewed at: http://oig.hhs.gov/reports-and-publications/workplan/index.asp#current .
CMS ISSUES FINAL 2012 ASC RULE: IMPROVEMENTS IN PAYMENT RATES AND QUALITY REPORTING PROGRAM
CMS ISSUES FINAL 2012 ASC RULE: IMPROVEMENTS IN PAYMENT RATES AND QUALITY REPORTING PROGRAM
Michael A Romansky, JD, Washington Counsel, OOSS
On November 1, CMS released its final CY 2012 Medicare ASC payment regulation. In summary, rates for cataract and other anterior segment services will increase slightly while some retina and glaucoma procedures will receive more generous payment increases. With respect to the new quality reporting program (QRP) proposed by CMS, the agency adopted some of the recommendations made by OOSS and the ASC community to make the new system more equitable and less burdensome to facilities.
Payment Rates
As you may recall, under the ASC payment system, facilities receive a percentage of the relative weight assigned to a code for procedures furnished in HOPDs. The relative weights are recalibrated each year based under a complex formula that takes into account a number of factors, including changes in hospitals’ costs in providing such services and the mandate that the ASC payment system remain budget-neutral.
The 2012 rate proposal again contemplated an inflation update for ASCs based upon the Consumer Price Update –Urban (CPI-U), minus a “productivity adjustment” (MFP) mandated by the health care reform law – totaling 0.9 percent. The final rule, which incorporates an updated and higher CPI-U factor and a lower MFP, generates a 2012 Medicare ASC update of 1.6 percent. (CMS did once again did not adopt the ASC community’s recommendation that our rates be updated by the Hospital Market Basket, which is used as the inflator for hospitals and is typically about a point higher.)
Proposed 2012 payment rates for an illustrative selection of high-volume ophthalmic services are as follows:
ASC Quality Reporting
The new ASC quality reporting program is by far the most significant element of the proposed regulation.
· Effective Date. The proposed rule would have required ASCs to commence reporting on January 1, 2012. The final rule defers the date for the submission of quality date until October 1, 2012.
· Quality Measures. Effective October 1, 2012 (and for the 2014 payment determination), ASCs will be required to report on: patient burns; patient falls in the ASC; wrong site, wrong side, wrong patient, wrong procedure, wrong implant; hospital transfer/admission; and prophylactic IV antibiotic timing. (CMS deleted the measures forhair removal and selection of prophylactic antibiotic. In 2013 (and for the 2015 payment determination), ASCs will additionally report on safe surgical checklist use and ASC facility volume for selected surgical procedures. In 2014, in addition to potential measures in specialty areas, CMS will add influenza vaccination coverage among healthcare personnel.
· Penalties. CMS is empowered to confer penalties up to 2 percent on facilities that fail to comply with quality reporting requirements. The ASC community recommended that penalties be phased in over time. CMS announced that it will not determine how penalties will be imposed until the 2013 ASC regulation is published next summer.
Most of these measures were developed by the ASC Quality Collaborative. OOSS is the only ophthalmology organization that is a member of this organization. We will work to ensure that appropriate and reasonable measures are developed and applied to ophthalmic ASCs in the future.
New Technology Intraocular Lens (NTIOL) Requests
ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS denied NTIOL status for applications submitted on behalf of: Alcon Laboratories, for four models of its Acrysof Natural IOL under a new class of such lenses for blue-light filtering to improve driving safety under glare conditions;Bausch & Lomb, for its Xact IOLs, claiming that their “glistening-free” capacities address problems with decreased contrast sensitivity, increased glare, decreased visual activity, and impaired fundus visualization; Hoya Surgical Optics, for its iSert IOL System, claiming a number of benefits, e.g., reduced complications and accelerated recovery; and, Lenstec, for its Softec HD PS lens, claiming “reduction of postoperative residual refractive error.”
OOSS Action on this Rule and Legislation
We are disappointed, but not surprised, by CMS’ action on the 2012 update. OOSS’ position is very simple: ASC payment rates should be updated annually by the same factor used to update hospital rates: the Hospital Market Basket. We will continue to make our case at CMS for appropriate modifications to the rates and quality reporting program and policies underlying them. OOSS will also continue to seek enactment of legislation in Congress that will make necessary systemic reforms to the payment system. As we learned a couple of weeks ago when CMS repealed the onerous same day surgery rule, we can make a difference!
OOSS will keep you abreast of further developments. Should you have any questions regarding the rule, please contact our Washington Counsel Michael Romansky atmromansky@OOSS.org.
To review the final ASC payment rule: http://www.ofr.gov/OFRUpload/OFRData/2011-28612_PI.pdf .
To review the 2012 rates: http://www.cms.gov/ASCPayment/ASCRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1253623&intNumPerPage=10
Should you have any questions regarding the rule, please contact OOSS Washington Mike Romansky at mromansky@OOSS.org or at 301.332.6474
MAJOR OOSS VICTORY: OBAMA ADMINISTRATION, CMS REPEAL PROHIBITION ON SAME DAY SURGERY
MAJOR OOSS VICTORY: OBAMA ADMINISTRATION, CMS REPEAL PROHIBITION ON SAME DAY SURGERY
The Obama Administration announced today the withdrawal of a host of regulations “unnecessary, obsolete, or burdensome . . . to American hospitals and healthcare providers.” Among those repealed is the Medicare rule long fought by OOSS (and allies AAO, ASCRS, and the ASC Association) that prohibited the performance of surgery in an ASC on the same day as the diagnosis and referral to the facility. This regulation has, for the past two years, essentially precluded an ophthalmologist from seeing his patient in the clinic and performing a Yag on the same day, causing great inconvenience to the patient and his family.
A new final regulation, that will become effective December 23, will allow the ASC to provide the patient, the patient’s representative, or the patient’s surrogate to provide the patient rights information prior to the start of the surgical procedure. Notice must be verbal and in written form.
CMS also issued a proposed rule eliminating the specific list of emergency equipment ASCs must have on hand, and allowing facilities, in conjunction with medical staff and their governing bodies, to develop policies and procedures that specify emergency equipment appropriate to the services they provide.
Should you have any questions, please contact OOSS’ Washington Counsel, Michael A. Romansky, at mromansky@OOSS.org.
To review OOSS’ comments on this issue: click here.
To review CMS’ press release: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4123&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
To review the final same-day surgery rule: http://www.cms.gov/
To review the proposed ASC emergency equipment rule: http://www.ofr.gov/OFRUpload/OFRData/2011-27175_PI.pdf
ASC Reform Legislation Making Steady Gains on Capitol Hill
ASC Reform Legislation Making Steady Gains on Capitol Hill
As reported earlier this summer, House and Senate health leaders introduced landmark legislation – The Ambulatory Surgical Center Quality and Access of 2011 — developed by OOSS, the ASC Association, and others that would accomplish several important goals. First, it would provide ASCs with the same inflation update afforded hospital outpatient departments. Second, it would reverse CMS’ current regulation that precludes an ASC from performing surgery on a patient the same day that the surgeon refers the patient to the facility, a policy that has unnecessarily inconvenienced thousands of Yag patients. Third, it provides important protections and safeguards for facilities in contemplation of CMS’ implementation of a new ASC quality reporting program. For a detailed Bill Summary, click here: QUALITY AND ACCESS ACT OF 2011.
The House version of the bill, H.R. 2108, is co-sponsored by: Representatives Pete Sessions (R-Tx); Shelley Berkley (D-Nv); Marsha Blackburn (R -Tn); Michael Burgess (R-Tx); G.K. Butterfield (D-NC); Bill Cassidy (R-La); Bill Flores (R-Tx); Tim Griffin (R-Az); Ralph Hall (R-Tx); Doc Hastings (R-Wa); Larry Kissell (D-NC); John B. Larson (D-Ct); Kenny Marchant (R-Tx); Cathy McMorris Rodgers (R-Wa); Jerry McNerney (D-Ga); Michael H. Michaud (D-Me); Randy Neugebauer (R-Tx); Richard Nugent (R-Fl); Steven M. Palazzo (R-Ms); David P. Roe (R-Tn); Dennis Ross (R-Fl); Mike Ross (D-Az); David Schweikert (R-Az); Adam Smith (D-Wa); Ed Whitfield (R-Ky); and, Don Young (R-Ak). The Senate version of the bill, S. 1173, is sponsored by Senator Ron Wyden (D-Or) and co-sponsored by Senators Mike Crapo (R-Id) and Mary Landrieu (D-La).
You will receive an OOSS Washington Update Online within the next week requesting your grassroots efforts in securing more cosponsors to this important legislation. Just a few clicks of the keyboard is all it will take to ask your Representative or Senator to cosponsor the bill. Stay tuned . . .
PA Hospital Assn Takes Shots at Surgery Centers; PA ASC Assn Responds
PA Hospital Assn Takes Shots at Surgery Centers; PA ASC Assn Responds
In a self-serving and misleading interpretation of a Pennsylvania Health Care Cost Containment Council Report on the Financial Health of Pennsylvania’s Ambulatory Surgery Center’s, the Hospital and Healthsystem Association of Pennsylvania (HAP) claimed this week that high ASC profit margins are the result of ASCs “treating healthier, and usually better insured, patients {while} the financial and clinical demands on acute care hospitals, which are a safety net for all Pennsylvanians, continue to grow to grow.”
The HAP statement failed to mention that the Cost Containment Council reported only nominal growth in the number of surgery centers, ASC visits, and ASC volume in recent years. The Pennsylvania Ambulatory Surgery Association responded to both the Report and HAP’s claims: The Association notes that in calculating the operating margins for ASCs, disbursements to physician owners and the tax payments they made were not counted as overhead and, therefore, were not properly deducted from final margin figures. Moreover, unlike hospitals, when ASCs provide free or discounted care, they receive no subsidies or financial incentives. Moreover, Medicare reimburses the ASC only 56% of the amount it pays the hospital for the same service. Finally, ASCs are small businesses that, unlike hospitals, pay state and local taxes.
The complete Pennsylania Council Report can be reviewed at: http://www.phc4.org/reports/fin/10/docs/fin2010report_volumetwo.pdf.
The Pennsylvania Ambulatory Surgery Association statement can be reviewed at: http://www.pasa-asf.org/Documents/9-28-11ASCresponsetoPHC4reports.pdf.
