CMS RELEASES REVISED
(AND STILL UNSATISFACTORY)
CATARACT MEASURE SPECS

Since last summer, OOSS has worked tirelessly with the ophthalmology and ASC communities to reverse CMS’ initiative to require facilities to report on ASC 11: Cataracts—Improvement in Patient’s Visual Function Within 90 Days Following Cataract Surgery.  To date, while the start of the reporting period has been delayed from January 1 to April 1, 2014, the agency has been unwilling to withdraw the measure, instead attempting to “fix” the misguided effort with ineffective and sometimes confusing modifications to the measure’s specifications.  While OOSS continues to aggressively seek the measure’s repeal, we want to keep you fully up to date on what CMS will be expecting April 1 and going forward.

Why Do We Object to the Measure?

In order to improve the quality of care provided to consumers by the facility, any ASC quality measure should relate to the episode of care within the ASC, encompass data that is available within the ASC, be collectable by ASC staff, and produce conclusions that are actionable by the facility.  This measure meets none of these benchmarks. ASC-11 relates to the care provided by the surgeon, not the ASC, and as such, any conclusions generated by the reported data will be irrelevant to the improvement of care by the facility.  The ASC does not have such data in its patients’ charts. The measure’s application to the ASC is unnecessary and redundant as the same data is reported under PQRS. MedPAC and other entities have admonished that it is inappropriate to migrate a measure from the physician’s office to the ASC without testing it on a pilot basis (which has not been done). Compliance with this measure will place administratively excessive burdens on the ASC and surgeon with no attendant improvement in the care provided by the ASC.

What Will Ophthalmic ASCs Be Required to Do?

We strongly recommend that you carefully review the relevant sections of the ASC QR Specifications Manual 3.0b and the accompanying ASC QR Specifications Manual 3.0b Release Notes.  These are some important highlights:

•  Who Must Report: All ASCs that are Medicare-certified must report, regardless of specialty or case mix.
•  What Must Be Reported:  Facilities will report the “percentage of patients 18 and older who had cataract surgery and completed both a pre-operative and post-operative visual function instrument.”
•  Survey Instrument:  Facilities must use an “assessment tool that has been validated for the population for which it is being used.” Examples include, but are not limited to: National Eye Institute – Visual Function Questionnaire, the VF-14, the modified VF-8, the Activities of Daily Vision Scale (ADVS), the Catquest, and the modified Catquest-9.  The same data collection instrument must be used pre-operatively and post-operatively.
•  Sample Size: Facilities with 0 to 900 patients will be required to report on a yearly sample of 63 patients.  ASCs with 901 or more cases will report on a sample of 96 patients.  Statements by agency officials lead us to believe that ASCs will have substantial flexibility in determining which patients are included in the sample.
•  Collection of Data:  CMS Recommends that the facility obtain the survey results from the surgeon.  However, the agency will permit facilities to administer the surveys via phone, mail, email, or during clinician follow-up.  Clearly, the facility and physician’s office will need to coordinate their efforts and delineate the requisite responsibilities to ensure compliance with the measure. (OOSS is exploring with vendors with patient experience survey and benchmarking experience arrangements that might facilitate ophthalmic ASCs’ compliance with ASC-11 and future measures.)
•  Key Dates:  Facilities will be required to collect data for patients receiving care from April 1, 2014 through December 31, 2014.  Data will be submitted January 1, 2015 through August 15, 2015.  Failure to report on ASC-11 will result in a two-percent reduction in payment updates for CY 2016.  Data will be reported through the QualityNet portal.

What is OOSS Doing to Eliminate or Modify ASC-11 as a Quality Measure?

OOSS is working closely with ASCRS, AAO, and the Ambulatory Surgery Center Association to persuade policymakers to withdraw ASC-11.  To this end:

•  We have been engaged in high-level discussions with CMS urging that the measure be withdrawn or delayed pending pilot testing of ASC-11 in the ASC environment.
• We have secured key Congressional support for this effort with letters transmitted by key legislators to the CMS leadership urging the same.
• We are working with the hospital industry in lobbying for withdrawal or delay, as HOPDs face the same challenges in reporting on this measure.
• As a member of the board of the ASC Quality Collaboration, we will be working with the ASCQC and the ophthalmology community in to expeditiously develop appropriate and meaningful alternative ophthalmic quality measures.  Among those under consideration (and already communicated to CMS):  wrong IOL and unplanned vitrectomies.

These advocacy efforts are very fluid and we are as yet uncertain whether ASC-11 might be repealed, its application suspended, or its specifications further modified to render it less burdensome on facilities and surgeons.  OOSS will keep you posted on these developments. Moreover, as the currently scheduled April 1 launch approaches, we will continue to educate you on a real time basis as to what will be required of ophthalmic centers.

Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.

These are some important highlights:

•  Who Must Report: All ASCs that are Medicare-certified must report, regardless of specialty or case mix.
•  What Must Be Reported:  Facilities will report the “percentage of patients 18 and older who had cataract surgery and completed both a pre-operative and post-operative visual function instrument.”
•  Survey Instrument:  Facilities must use an “assessment tool that has been validated for the population for which it is being used.” Examples include, but are not limited to: National Eye Institute – Visual Function Questionnaire, the VF-14, the modified VF-8, the Activities of Daily Vision Scale (ADVS), the Catquest, and the modified Catquest-9.  The same data collection instrument must be used pre-operatively and post-operatively.
•  Sample Size: Facilities with 0 to 900 patients will be required to report on a yearly sample of 63 patients.  ASCs with 901 or more cases will report on a sample of 96 patients.  Statements by agency officials lead us to believe that ASCs will have substantial flexibility in determining which patients are included in the sample.
•  Collection of Data:  CMS Recommends that the facility obtain the survey results from the surgeon.  However, the agency will permit facilities to administer the surveys via phone, mail, email, or during clinician follow-up.  Clearly, the facility and physician’s office will need to coordinate their efforts and delineate the requisite responsibilities to ensure compliance with the measure. (OOSS is exploring with vendors with patient experience survey and benchmarking experience arrangements that might facilitate ophthalmic ASCs’ compliance with ASC-11 and future measures.)
•  Key Dates:  Facilities will be required to collect data for patients receiving care from April 1, 2014 through December 31, 2014.  Data will be submitted January 1, 2015 through August 15, 2015.  Failure to report on ASC-11 will result in a two-percent reduction in payment updates for CY 2016.  Data will be reported through the QualityNet portal.

What is OOSS Doing to Eliminate or Modify ASC-11 as a Quality Measure?

OOSS is working closely with ASCRS, AAO, and the Ambulatory Surgery Center Association to persuade policymakers to withdraw ASC-11.  To this end:

•  We have been engaged in high-level discussions with CMS urging that the measure be withdrawn or delayed pending pilot testing of ASC-11 in the ASC environment.
• We have secured key Congressional support for this effort with letters transmitted by key legislators to the CMS leadership urging the same.
• We are working with the hospital industry in lobbying for withdrawal or delay, as HOPDs face the same challenges in reporting on this measure.
• As a member of the board of the ASC Quality Collaboration, we will be working with the ASCQC and the ophthalmology community in to expeditiously develop appropriate and meaningful alternative ophthalmic quality measures.  Among those under consideration (and already communicated to CMS):  wrong IOL and unplanned vitrectomies.

These advocacy efforts are very fluid and we are as yet uncertain whether ASC-11 might be repealed, its application suspended, or its specifications further modified to render it less burdensome on facilities and surgeons.  OOSS will keep you posted on these developments. Moreover, as the currently scheduled April 1 launch approaches, we will continue to educate you on a real time basis as to what will be required of ophthalmic centers.

Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.