ADVOCACY SPOTLIGHT
BY DAVID OPONG-WADEE | APRIL 2024
Senator Mike Braun (R-IN), a leading voice in the Senate Health, Education, Labor and Pensions (HELP) Committee, is a strong advocate for ASCs. He has a small business background, understands the challenges surgery centers face and is committed to “fixing our broken healthcare system and strengthening workforce development.”
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BY DAVID OPONG-WADEE | MARCH 2024
The 118th Congress has tackled healthcare with fervor, scrutinizing consolidation and demanding transparency. The particularly turbulent environment that has prevailed since this session’s start has presented both threats and opportunities for ASCs.
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BY STEPHEN ABRESCH | FEBRUARY 2024
In 2023, ASCA tracked more than 650 bills across the 50 states for potential impacts on ASCs. Certain trends from past years continued, like the focus on surgical smoke evacuation requirements and state-level price transparency requirements. New, disturbing trends also arose, including facility fee prohibition proposals across the country.
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BY MAIA KUNKEL | JANUARY 2024
National Advocacy Day will return this year. From February 26–28, participants will convene in Washington, DC, to network with their peers, meet with their members of Congress and staff, and help create lasting change for surgery centers across the country.
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BY STEPHEN ABRESCH | NOVEMBER-DECEMBER 2023
Missouri became the latest state to join a growing number of states with surgical smoke evacuation requirements when Missouri Governor Mike Parson signed HB 402 into law last summer, enacting surgical smoke evacuation requirements for ASCs and hospitals. Primarily pushed at the state level by the Association of periOperative Registered Nurses (AORN), the issue has seen sustained interest since Rhode Island enacted the first requirement in 2018.
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BY KARA NEWBURY | OCTOBER 2023
Every summer, typically in early to mid-July, the Centers for Medicare & Medicaid Services (CMS) releases its proposed payment rule for ASCs and hospital outpatient departments (HOPD) for the coming year. This rule contains proposed updates to Medicare’s reimbursement rates, proposed changes to the list of procedures ASCs will be able to provide to Medicare beneficiaries and proposed changes to the ASC Quality Reporting (ASCQR) Program.
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BY BRIANNA THOMAS | SEPTEMBER 2023
The Texas legislature met from January to May this year and Texas Ambulatory Surgery Center Society (TASCS) members made the most of that time educating their elected officials about ASCs and advocating for policies that support the ASC community.
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INTERVIEWED BY MAIA KUNKEL | AUGUST 2023
After meeting with a constituent during National Advocacy Day last spring, Representative Mike Bost (R-IL), former Illinois House of Representatives Republican caucus chair, firefighter and US Marine Corps corporal, signed up to be a cosponsor of the Outpatient Surgery Quality and Access Act of 2023 (H.R. 972/S. 312).
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INTERVIEWED BY MAIA KUNKEL | JUNE-JULY 2023
Linda Bedwell, RN, CASC, director of Powder River Surgery Center in Gillette, Wyoming, recently participated in ASCA’s first in-person National Advocacy Day in more than three years.
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BY KARA NEWBURY | MAY 2023
Medicare beneficiaries who receive treatment in either an ASC or a hospital outpatient department (HOPD) are typically responsible for 20 percent of their cost of care. In HOPDs, this 20 percent copay is capped at the hospital inpatient deductible amount ($1,600 for 2023). In ASCs, however, there is no copay cap.
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INTERVIEWED BY SAHELY MUKERJI | APRIL 2023
Catherine Ruppe, RN, CASC, associate principal at ECG Management Consultants in Seattle, Washington, is a member of ASCA’s State Affairs Committee. She talked to ASC Focus about a pipeline program that she started for high school students interested in entering the nursing profession.
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BY ALEX TAIRA | MARCH 2023
In recent years, Congress and the Centers for Medicare & Medicaid Services (CMS) have enacted several policy changes that improve access to colorectal cancer (CRC) screening. This includes closing a loophole that allowed patients to be charged coinsurance if a polyp were discovered during a screening colonoscopy, lowering the coverage age for CRC tests and expanding the types of CRC tests covered by Medicare.
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BY STEPHEN ABRESCH | FEBRUARY 2023
As the COVID-19 pandemic faded from state legislative agendas, state legislatures in 2022 turned back to regular business, including core issues affecting ASC operations.
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INTERVIEWED BY SAHELY MUKERJI | JANUARY 2023
Congressman Brad Wenstrup, DPM (R-OH), a US Army reserve officer, combat surgeon and doctor of podiatric medicine, cosponsors the Outpatient Surgery Quality and Access Act of 2021. He will re-introduce the legislation with Congressman John Larson (D-CT) in the 118th Congress.
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BY STEPHEN ABRESCH | NOVEMBER-DECEMBER 2022
Alaska, Delaware, Illinois and Ohio have now finalized changes to regulations governing ASCs, aligning them with changes made by the Centers for Medicare & Medicaid Services (CMS) in 2019. All four states amended their medical history and physical examination (H&P) requirements in the last 12 months, while Alaska and Illinois also changed their written transfer agreement requirements.
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BY STEPHEN ABRESCH | OCTOBER 2022
Beginning September 9, ASCs in Pennsylvania no longer need to submit waivers to perform some common procedures routinely performed in ASCs in other states, including various total joint, laparoscopic, laparoscopic cholecystectomy, and dialysis and vascular access procedures.
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BY DAVID OPONG-WADEE | SEPTEMBER 2022
As in the past, ASCA has partnered with Voices for Non-Opioid Choices (Voices) to support the introduction of the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 586/ H.R. 3259) in Congress. As of June 2022, the legislation has more than 150 cosponsors, with more than 100 in the House and more than 50 in the Senate. The bill has seen significant traction and the provisions it contains could pass individually or be adopted in a larger legislative mechanism before the end of this Congress.
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BY MAIA KUNKEL | AUGUST 2022
Despite state-level shutdowns of elective procedures, multiple shortages of personal protective equipment (PPE) and staff, and countless surges of COVID-19 cases that arrived alongside the pandemic, ASCs have continued advocating for their centers.
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INTERVIEWED BY STEPHEN ABRESCH | JUNE-JULY 2022
Krista DuRapau, executive director of the Texas Ambulatory Surgical Center Society, sees membership as the main drive for successful advocacy work.
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INTERVIEWED BY STEPHEN ABRESCH | MAY 2022
Elizabeth “Beth” LaBouyer, executive director of the California Ambulatory Surgery Association, has fought long and hard to protect the ASC model of care in her state.
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INTERVIEWED BY SAHELY MUKERJI | APRIL 2022
Naya Kehayes is the principal and ambulatory surgery practice leader at ECG Management Consultants in Seattle, Washington. She is a member of ASCA’s Government Affairs Committee, a board member of the Washington Ambulatory Surgery Center Association and the chair of its Payment Policy Committee, and a mentor at Yale University School of Medicine’s Department of Public Health.
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BY ALEX TAIRA | MARCH 2022
On October 22, 2021, two US representatives, Ami Bera (D-CA) and Larry Buschon (R-IN), sent a letter to Speaker of the House Nancy Pelosi and Minority Leader Kevin McCarthy. In the letter, the two representatives, both doctors, asked the congressional leaders to address imminent Medicare payment cuts that would have reduced reimbursement to a group of Medicare service providers, including physicians and ASCs, by “at least 9 percent.” The cuts, the letter said, would “strain our healthcare system and jeopardize patient access to medically necessary services.”
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BY STEPHEN ABRESCH | FEBRUARY 2022
Percutaneous coronary intervention procedures, also referred to as PCI procedures and coronary angioplasties, have traditionally been performed on an inpatient basis. In May 1999, the Journal of Invasive Cardiology published the first randomized study demonstrating that same-day discharge after PCI is as safe and effective as performing the procedure on an inpatient basis.
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BY STEPHEN ABRESCH | JANUARY 2022
After spending most of 2020 grappling with the COVID-19 pandemic, state legislatures in 2021 were able to dedicate more time to addressing other concerns, even though legislation related to the pandemic still featured heavily on legislative dockets.
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INTERVIEWED BY SAHELY MUKERJI | NOVEMBER-DECEMBER 2021
Jessica Rodriguez, CASC, is the executive director of OAM Surgery Center at MidTowne in Grand Rapids, Michigan. She serves as the secretary of the Michigan Ambulatory Surgery Association.
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BY STEPHEN ABRESCH | OCTOBER 2021
Connecticut Governor Ned Lamont (D) signed a two-year state budget implementer bill, SB 1202, into law in June. The budget implementer contained policy provisions impacting various state laws, including one with big implications for ASCs: an overhaul of the state’s ASC gross receipts tax.
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INTERVIEWED BY SAHELY MUKERJI | SEPTEMBER 2021
Gregory Horner, MD, managing partner of HealthPoint Surgery Center Management in Newbury Park, California, serves as the chairman of the ASCAPAC Board of Directors.
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BY ADAM PARKER | AUGUST 2021
As we transition out of the pandemic, ASC professionals need to keep sharing their stories, especially from the past year, with policymakers to educate them about the longstanding issues that ASCs face.
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INTERVIEWED BY SAHELY MUKERJI | JUNE-JULY 2021
Annie Sariego, RN, CASC, market president of Physicians Endoscopy (PE) GI Solutions, in Jamison, Pennsylvania, serves as the chair of ASCA’s Government Affairs Committee.
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INTERVIEWED BY SAHELY MUKERJI | MAY 2021
Gary Richberg, RN, CASC, ASCA Board member and director of Ambulatory Surgery Centers at Kadlec Clinic, a division of Providence Healthcare, in Richland, Washington, has been involved with ASCA in different capacities for 20 years. He is a strong advocate for the ASC community and shares the insight that he gained through experience.
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INTERVIEWED BY SAHELY MUKERJI | APRIL 2021
Amanda Hawkins, CASC, director of The Surgery Center of Charleston in Charleston, South Carolina, joined the ASCA Board of Directors in 2019. She will serve a three-year term. All members of the ASCA Board also serve on the ASCA Foundation Board.
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BY STEVE SELDE | MARCH 2021
On December 27, 2020, President Donald Trump signed H.R. 133, the Consolidated Appropriations Act, 2021, into law. Among its many provisions, this law protects patients from surprise medical bills from out-of-network providers and creates an independent dispute resolution (IDR) process to resolve billing disputes between out-of-network care providers and health plans.
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BY SAHELY MUKERJI | FEBRUARY 2021
As part of its mission to support the collection and reporting of quality data, the ASC Quality Collaboration (ASC QC) conducted a survey of more than 700 ASCs during the early days of the COVID-19 pandemic when surgeries were limited to urgent and emergent cases.
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BY STEVE SELDE | JANUARY 2021
In December 2019, the Senate confirmed Stephen Hahn, an oncologist and top official at MD Anderson Cancer Center, as commissioner of the Food & Drug Administration (FDA).
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BY STEVE SELDE | NOVEMBER-DECEMBER 2020
The 116th Congress that convened on January 3, 2019, has been a busy and unusual Congress, with active consideration of a number of healthcare-related issues.
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BY STEVE SELDE | OCTOBER 2020
Over the years, ASCA has had many successes in changing federal policy with the support and help of its members. Looking back over at our successes on the federal level over the last few years, 2016 stands out.
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INTERVIEWED BY SAHELY MUKERJI | SEPTEMBER 2020
ASCA’s Board of Directors elected Michael J. Patterson, RN, CASC, as ASCA Board president in May. He will serve a two-year term. All members of ASCA’s Board also serve on the ASCA Foundation Board.
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BY SAHELY MUKERJI | AUGUST 2020
ASCA named Bill Wilcox, retired vice chairman of Tenet Healthcare Corporation in Dallas, Texas, and retired chairman and chief executive officer of United Surgical Partners International (USPI) in Addison, Texas, and Randy Leffler, the recently deceased executive director of the Ohio Association of Ambulatory Surgery Centers, as the recipients of its 2020 Nap Gary Legacy Award for Lifetime Achievement in the ASC Community.
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BY ADAM PARKER | JUNE-JULY 2020
Every August, ASCA collaborates with its member ASCs and helps them host facility tours for their members of Congress to celebrate National ASC Month. Your surgery center could be the greatest advocacy tool in your effort to raise awareness about the ASC community with your elected officials.
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BY STEVE SELDE | MAY 2020
Medicare spending is estimated to be $765 billion in fiscal year (FY) 2020. Most of that spending, like payments from Medicare to your ASC and physicians, is subject to a 2 percent reduction to what Medicare pays you, under what is called sequestration.
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INTERVIEWED BY STEVE SELDE | APRIL 2020
Congressman John B. Larson represents Connecticut’s 1st congressional district in the US House of Representatives. See what he has to say about the ASC Quality and Access Act and how its supporters can be more involved in the political process.
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BY STEVE SELDE | MARCH 2020
Opioids, according to the Centers for Disease Control and Prevention (CDC), are the main driver of drug overdose deaths and accounted for 47,600 deaths in 2017 alone.
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INTERVIEWED BY SAHELY MUKERJI | FEBRUARY 2020
Ann Shimek, RN, CASC, became executive director of the ASC Quality Collaboration (ASC QC) in September 2019. See what she has to say about her role and her plans for her first year as the ASC QC leader.
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BY ALEX TAIRA | JANUARY 2020
Fact- and data-based studies that show ASCs provide high-quality and low-cost care make for a powerful tool to educate legislators about the many benefits ASCs provide.
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BY ADAM PARKER | NOVEMBER-DECEMBER 2019
It has been almost 50 years since the first ASC opened its doors. Two physicians, Wallace Reed, MD, and John Ford, MD, established the first ASC in Phoenix, Arizona, in 1970 to provide timely, convenient and comfortable surgical services to patients in their community.
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BY LEAH BINDER | OCTOBER 2019
People, today, expect background information on nearly every good or service they seek, and that includes healthcare services. In the last century, we did not have the measures or systems in place to compare health providers, but that has changed in the digital age.
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BY STEVE SELDE | SEPTEMBER 2019
Over the last two years, Democrats on the campaign trail have used “Medicare for All” as a slogan and to describe a variety of policy proposals. In the 116th Congress, almost a dozen bills have been introduced that fall under the “Medicare for All” umbrella.
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BY STEVE SELDE | AUGUST 2019
For this session of Congress, ASCA’s main legislative priority is the ASC Quality and Access Act. This bill would help ensure that your ASC can continue to provide high-value care for Medicare beneficiaries in your community.
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BY MEAGH GRAHAM | JUNE-JULY 2019
ASCs provide high-quality, economically priced care, yet many policymakers don’t know about the countless benefits that ASCs provide to their patients and the community. Hosting a tour of your center for a policymaker gives you the unique opportunity to show them firsthand the benefits your ASC provides.
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BY DANIELLE KASTER | MAY 2019
What is advocacy? Does it even matter?
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BY ALI LEGROS-MURPHY | APRIL 2019
Each year, ASCA’s State Affairs Committee hosts a State Leaders Conference. With growing participation, the conference has become the signature event for networking and learning about state ASC advocacy.
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BY JEFF EVANS | MARCH 2019
According to the Centers for Disease Control and Prevention (CDC), colorectal cancer (CRC) is the third-most diagnosed and second-most deadly cancer in America. In 2017, approximately 135,000 people were diagnosed with CRC. And while death rates associated with CRC have declined for several decades, roughly 50,000 people succumb to the disease each year.
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BY JEFF EVANS | FEBRUARY 2019
According to an estimate from the US Drug Enforcement Administration, more than 72,000 Americans died in 2017 from drug overdoses. Preliminary data show 49,060 of these deaths were related to opioids—an increase from 42,249 in 2016.
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BY JEFF EVANS | JANUARY 2019
Stakeholders across the country helped make 2018 a productive year for ASC advocacy. In 2019, ASC supporters will have many more opportunities to help protect and promote patient access to the efficient, high-quality and cost-effective care ASCs provide.
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BY MICHAEL SCHEERHORN | NOVEMBER-DECEMBER 2018
On behalf of ASCs across the country, and in collaboration with the state ASC associations, ASCA monitors policymaking in every state to ensure centers are not burdened with ill-conceived regulatory policies that could jeopardize the ASC model.
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BY ALI LEGROS-MURPHY | OCTOBER 2018
At the Arizona Ambulatory Surgery Center Association’s (AASCA) annual meeting this year, members from around the state came together to learn, network and give back.
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BY JEFF EVANS | SEPTEMBER 2018
In 2016, opioids were involved in 42,249 deaths, five times higher than in 1999, according to the Centers for Disease Control and Prevention (CDC). Today, through legislation and administrative policy, the federal government has committed significant resources into opioid crisis response. It took a few years, but the paradigm has shifted from concern to increased action as human loss continues to grow.
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BY JEFF EVANS | AUGUST 2018
Access to health care information has come under increased scrutiny in the US Congress, and momentum for better transparency is building. In February, a bipartisan group of senators requested information from health care stakeholders regarding cost of care and price transparency.
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BY JEFF EVANS | JUNE-JULY 2018
In 2014, the US Congress passed the Veterans’ Access to Care Through Choice Accountability and Transparency Act, commonly referred to as the Choice Act. Precipitated by several health care scandals within the US Department of Veterans Affairs (VA), this important legislation established the Veterans Choice Program (VCP), which increased veterans’ access to care providers outside of the VA. Since 2014, community care appointments have increased 61 percent overall, according to a 2016 VA report.
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BY DANIELLE KASTER | MAY 2018
While awareness of the ASC industry has grown, many lawmakers still lack a full understanding of how ASCs positively affect America’s health care industry. Facility tours play a powerful role in educating lawmakers and influencing the legislative process. During the facility visit, policymakers directly observe how their policies affect patients and ASCs.
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BY ALI LEGROS-MURPHY | APRIL 2018
ASCA works with ASC advocates in states across the country to support legislative initiatives that protect patient access to ASCs and defeat proposals that jeopardize ASCs’ ability to deliver top-quality care. Excerpts from interviews with two state-based advocates who fought to protect the ASC model of care in their states follow.
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BY JEFF EVANS | MARCH 2018
March is National Colorectal Cancer Awareness Month and an opportunity to educate your community about the importance of colorectal cancer (CRC) screening. This month also is a good time to join with ASCA in national advocacy efforts aimed at promoting enhanced access to CRC screenings and the life-saving benefits these procedures provide.
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BY DANIELLE KASTER | FEBRUARY 2018
A political action committee (PAC) is an organization that raises money privately, among its members, to advocate for its industry or cause.
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BY DANIELLE KASTER | JANUARY 2018
Every day, local and federal lawmakers are making decisions that directly impact your livelihood and your patients. Despite growing support for ASCs, many policymakers remain uneducated about the important role surgery centers play in providing care to their constituents. Your voice is invaluable to the success of the ASC industry. Help educate these elected officials by becoming an ASC advocate.
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BY ALI LEGROS | NOVEMBER-DECEMBER 2017
In 2017, state lawmakers across the country filed more than 180,000 bills and enacted nearly 35,000 of those. Given that volume, it is not surprising that the ASC community found itself objecting to several legislative proposals during the 2017 legislative session.
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BY SAHELY MUKERJI | OCTOBER 2017
In July, state regulators of Vermont approved a certificate of need (CON) for the first multi-specialty and second independent ASC in the state. Amy Cooper, executive director of HealthFirst in Burlington, Vermont, talked to ASC Focus about her experience with the process that took three years to come to fruition.
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BY SAHELY MUKERJI | SEPTEMBER 2017
David G. Ornelas, CASC, chief operating officer at Colorado Clinic in Loveland, Colorado, volunteered as the state leader for Colorado during the “2017 If Not Now, When?” ASCAPAC State Competition. Colorado won the category of the most money raised with nearly $20,000. With a participation of 15 percent of state ASCs, Connecticut won the category with the highest percentage of participation. Lisa Winkler, executive director of Connecticut Association of Ambulatory Surgery Centers and partner at Innovate and Organize in Avon, Connecticut, was the state leader.
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BY DANIELLE KASTER | AUGUST 2017
For more than 40 years, ASCs have been providing patients with safe, affordable and innovative care. As a leader in the evolution of surgical care, ASCs not only benefit patients, but also save money for Medicare and third-party payers.
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BY KRISTIN MURPHY | JUNE-JULY 2017
Late last year, Congress passed the 21st Century Cures Act, which includes a version of the Electronic Health Fairness Act of 2015. The bipartisan bill, introduced by US Representatives Fred Upton (R-MI) and Dianne DeGette (D-CO) and signed into law by President Barack Obama on December 13, 2016, is a nearly 1,000-page legislative package that provides funding for the National Institutes of Health, the Food and Drug Administration and opioid abuse prevention.
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BY ALI LEGROS | MAY 2017
Each year, ASCA’s State Affairs Committee hosts a gathering for state leaders and state advocates from the ASC community to learn from and network with one another. The State Affairs Committee will continue this tradition in 2017 with its State Leaders’ Workshop, a smaller, more focused discussion session than in recent years.
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BY KRISTIN MURPHY | APRIL 2017
Recent studies prove what the ASC industry already knew: ASCs provide significant savings to Medicare and its beneficiaries. A growing disparity in payments between ASCs and hospital outpatient departments (HOPDs), however, is jeopardizing both the industry and patient access to high-quality, cost-efficient care.
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BY KRISTIN MURPHY | MARCH 2017
ASCA Board Member Tom Deas, Jr, MD, began his gastroenterology medical practice in Fort Worth, Texas, in 1991. Board certified by the American Board of Internal Medicine in both internal medicine (1981) and gastroenterology (1989), Deas served 20 years in the US Air Force, retiring as colonel, before starting his practice.
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BY KRISTIN MURPHY | FEBRUARY 2017
Nearly all legislation eventually approved by Congress is first considered in one or more of the many standing committees that exist in the House and Senate today. Several committees typically have jurisdiction over proposals that affect health care, Medicare and other issues essential to ASCs.
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BY ALI LEGROS | JANUARY 2017
Before we embark on the 2017 legislative session, let us recap the 2016 session. In 2016, more than 178,206 bills were filed across the country, and state lawmakers approved nearly 29,122 of them, making them 17 percent more productive than Congress. With that volume, the ASC industry saw several legislative issues arise. Many of those emerging issues are expected to be re-introduced in 2017.
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