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The OOSS Legislative and Regulatory Agenda for 2011 — A Quick Look Back
While we all await the impact of the forthcoming elections and a critical Supreme Court opinion on the landmark health care reform bill and Big Medicine continues its battle to resolve the seemingly endless SGR problem, the ASC community made real progress in satisfactorily resolving a number of important regulatory concerns. We’ll discuss these in greater details in an early January OOSS Update Online, but let’s highlight these accomplishments before ushering in what will be a very busy 2012 in the Nation’s Capital.
• Same Day Surgery. OOSS was instrumental in persuading CMS to repeal the onerous Medicare Condition for Coverage that prevented surgeons from performing Yag and other procedures on a patient in an ASC on the same that the patient was referred to the facility.
• Higher ASC Update. Although CMS again rejected the ASC industry’s recommendation that facilities receive the Hospital Market Basket rather than the Consumer Price Index as an annual inflator, the agency did increase the ASC update from 0.9 percent in the proposed rule to 1.6 percent in the final regulation.
• Quality Reporting Program Delayed and Improved. The final ASC payment rule delayed the implementation of the new ASC quality reporting program until October 1, 2012, nine months later that the proposed January 1 start date – a change welcomed by the surgery center community. Moreover, the measures adopted by the agency were developed by the ASC Quality Collaboration, of which OOSS is a member.
• Growing Support for ASC Quality and Access Act. OOSS joins the ASC Association and other organizations in vehemently supporting The ASC Quality and Access Act of 2011, which represents a legislative wish list of our industry’s priorities in Washington. Through aggressive lobbying, grassroots activity by our members, and targeted political support of our Hill allies with OOSPAC funds, cosponsorship of the legislation has grown to include 5 Senators and 38 Representatives.
Stay tuned for a detailed retrospective on our activities in Washington this past year and a look at the OOSS legislative and regulatory agenda for 2012.
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.ofr.gov/OFRUpload/OFRData/2011-27171_PI.pdf
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.
Enhance the Performance of Your ASC with New Online Modules
Many ophthalmologists have ownership interests in ambulatory surgical centers (ASCs). A majority of ophthalmic surgical cases in the US are performed in ASCs. To help ASCs perform at optimum efficiency and quality, the American Academy of Ophthalmic Executives (AAOE) have developed, with cooperation from the Ophthalmic Outpatient Surgery Society (OOSS), the Successful Ophthalmic ASC collection. Titles include: Administration, Operations and Procedures for the Ophthalmic ASC (#012404V); Complete Guide to Coding (#012405V); Designing and Building the Ophthalmic ASC (#012401V); Financial Reporting and Management (#012400V); and Managing ASC Quality and Performance (#012402V).
Download these modules today. Each is $45 for members and $60 nonmembers. Get 10% off when you purchase all five.
For more information, visit www.aao.org/store and click “Practice Management/AAOE.”
OOSS Benchmarking Tops 190
Over 190 facilities have participated in the 2011 Benchmarking survey so far with another 20 to 30 anticipated to submit results between now and January 31, 2012. The program is being enhanced in these key areas:
- First Release Report Timing. The first release of reports to facilities completing surveys by the September 2nd deadline is scheduled for December 2011 and early January 2012, two months earlier than prior years. It has taken much longer than anticipated due to the increased number of participants and report enhancements.
- Enhanced Reporting. The 2011 reports capture and compare year-end 2010 results similar to prior years, but with a substantially expanded measures based on feedback from facilities. The new format is easier to read, use and share for with your ASC team.
- Extended Survey Access. Survey access will remain open through January 31, 2012 to accommodate additional facilities and to expand the database. All participants, including those receiving the First Release report, will receive a Second Release report with regional comparisons (Northeast, Southeast, North Central and West).
The OOSS Benchmarking Initiative is designed exclusively for and by ophthalmic oriented ASCs. Leading the industry, OOSS benchmarking provides the most comprehensive, personalized, cost effective and convenient means of comparing, tracking and shaping ASC performance. To participant in the survey contact Dr. Kent Jackson at kjackson@ooss.org or by calling 303.910.7314.
POSSIBLE REPEAL OF BURDENSOM CMS LIMITS ON SAME DAY SURGERY NOW ON THE HORIZON
According to a White House Report issued this week, several regulations of interest to ASCs are part of a regulatory relief plan being undertaken by the Obama Administration and HHS, including one that OOSS has vociferously objected to since its inception two years ago. This regulation, part of the Medicare Conditions for Coverage, prohibits, except under narrow circumstances, a patient from receiving surgical care in an ASCon the same day that the surgeon refers him to the facility; the rule has had the onerous effect of precluding same day diagnosis for and performance of Yag procedures, much to the inconvenience of beneficiaries and consternation of surgeons. In April, OOSS Past-President Dr. Larry Patterson met with CMS officials to articulate our concerns with this rule and urge that it be repealed. We are pleased that the government now estimates that overturning this regulation will save Medicare $50 million annually.
The White House and HHS will also be reviewing rules governing the list of operating room emergency equipment that ASCs must have available as well as potentially duplicative infection control requirements.
The HHS regulatory relief plan may be reviewed at: http://www.slideshare.net/whitehouse/healthand-humanservicesregulatoryreformplanaugust2011
OOSS QUARRELS WITH CMS 2012 PROPOSED ASC PAYMENT RATES AND OFFERS IMPROVEMENTS TO NEW QUALITY REPORTING PROGRAM
OOSS joined the AAO and ASCRS in submitting comments to the Centers for Medicare and Medicaid Services (CMS) regarding its proposed 2012 ASC payment regulation. As in past years, we strenuously objected to CMS’ use of the Consumer Price Index (Urban) as the update factor for ASCs, urging instead that facilities be afforded the Hospital Market Basket, which is provided hospital outpatient departments and is typically about a point higher.
This regulation was significant in that CMS also proposed that ASCs be subject to quality reporting commencing January 1, 2012 and be subject to penalties in 2014. OOSS recommended that the new program be voluntary through 2013 and that the performance period commence in 2014. Moreover, penalties should start at no greater than 0.4 percent, consistent with the inpatient hospital program. OOSS comments also included substantive recommendations regarding data collection, measure development, future topics, and other important issues.
OOSS’ comments to CMS may be reviewed at FINAL AAO-ASCRS-OOSS Comments ASC 2012 NPRM 8-30-11.
The CMS proposed rule may be viewed at: http://www.gpo.gov/fdsys/pkg/FR-2011-07-18/pdf/2011-16949.pdf
For more information, contact Mike Romansky at mromansky@OOSS.org.
