Washington Update – April 1, 2014


OOSS members are well aware that the reporting period for ASC 11: Cataracts—Improvement in Patient’s Visual Function Within 90 Days Following Cataract Surgery commences on April 1.  Inconsistent and incorrect interpretations and clarifications regarding collection and reporting requirements by CMS and QualityNet have caused mass confusion among ASCs and hospitals.  Under the circumstances, what is the ophthalmic ASC to do?

With the implementation of ASC-11 Upon Us, What If We Have Not Figured Out Exactly What to Do?

There is no need to panic.  OOSS continues to make every conceivable effort to secure accurate answers to our many outstanding questions and provide meaningful guidance to you for purposes of compliance with ASC-11.  To reference a couple of these information gaps, it is unclear whether facilities and surgeons can modify existing VF instruments or whether ASCs, like ours, which perform no GI services, are required to report on ASC-9 or ASC-10.

REPORTING IS NOT REQUIRED IMMEDIATELY!  Data derived from the facility’s sample of patients who complete pre- and post-op VF instruments can be collected at any time prior to December 31, 2014; moreover, data need not be reported to CMS until August of 2015.   Clarifications will be forthcoming over the next few weeks and your centers can afford to let the dust settle a bit and make sound decisions about how to comply with ASC-11.

What Will Ophthalmic ASCs Be Required to Do?

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

  • Who Must Report: All ASCs that are Medicare-certified must report, regardless of specialty or case mix.  As such, with what we know at this point, ophthalmic facilities will be required to report on the two GI measures.
  • 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.  CMS and QualityNet have provided inconsistent answers regarding whether these instruments can be modified by the facility. 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 more 901 or more cases will report on a sample of 96 patients.  ASCs will have substantial flexibility in determining which patients are included in the sample.
  • Collection of Data:  The regulators are clearly recommending that the facility obtain the VF survey results from the surgeon.  However, the surveys may also be administered by the facility 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 the development of a program available to our members that would facilitate ophthalmic ASCs’ compliance with ASC-11 and future measures.)
  • Key Dates:  As noted above, 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, 2014.  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 Assist You in Your Compliance Efforts?

  • We will continue to keep you abreast on a real time basis of all relevant information over the next few weeks via these OOSS Updates Online.  Webinars will be offered as necessary.
  • Mike Romansky, our lobbyist, will devote his entire Washington Update to compliance with ASC-11 at OOSS Perspective 2014 in Boston.  Be sure to attend!
  • Mike is available to answer your questions as they arise – or refer you to other experts.  You can reach him at mromansky@localhost:8080/ooss.
  • As noted above, we are exploring making available to OOSS members a tool that would facilitate compliance with ASC-11 and other quality reporting requirements by automating data collection, providing summarized print-outs per patient of pre- and post-op results, and preparing ASC-11 data for easy submission to QualityNet, as well as assist in reporting on future quality measures.  More to come on this opportunity . . .

What is OOSS Doing to Eliminate or Delay This Measure?

We continue to engage in high-level discussions with CMS and Congress, urging that the measure be withdrawn or delayed pending pilot testing of ASC-11 in the ASC environment.

  • Working with the AAO, ASCRS, and Ambulatory Surgery Center Association, we have secured key Congressional support for this effort with letters transmitted by key legislators to the CMS leadership urging the same.
  • In an unprecedented effort, these organizations have signed on to a joint letter to CMS with the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges objecting to ASC-11 and urging it be withdrawn. Joint Letter
  • OOSS is taking the lead in working with the ASC Quality Collaboration and the ophthalmology community to expeditiously develop appropriate and meaningful alternative ophthalmic quality measures.  Among those under consideration (and already communicated to CMS):  wrong IOL and unplanned vitrectomies.

OOSS will be in constant communication with you over the next few weeks with respect to ASC-11.  Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.