One-on-One with an ASCA Board Member
Amanda Hawkins, CASC, talks about participating in the HWOW program
INTERVIEWED BY SAHELY MUKERJI | FEBRUARY 2021
Q: Tell me about your background and why you joined the ASCA Board.
Amanda Hawkins (AH): The ASCA community is unique, driven and enthusiastic. I have continued to be impressed with what ASCs have done to evolve our healthcare community. I knew I wanted to make a meaningful contribution and be a bigger part of ASCA. I had to broaden my understanding of ASCA and its advocacy and commit myself to learn more. I lobbied on Capitol Hill for South Carolina with Senator Tim Scott (R-SC), Senator Lindsey Graham (R-SC), former governor of South Carolina Mark Sanford and US Representative Tom Rice (R-SC-7th District) in 2015. I volunteered to participate on a committee and then, after my experience with the committee, applied to join the Board. I did not make it on the Board the first time but tried again. I have been heavily involved in my state association and also have served on the ASCAPAC Board to gain experience with the association. So far, my experience has been exceptional. I have had the opportunity to work with the most outstanding leaders in this industry, confronting challenges and making a difference in our ASC community. I will continue to commit myself to the ASCA Board and Foundation promoting the ASC community and its continued success.
Q: Why did you pursue the option to become a Hospitals Without Walls (HWOW) participant?
AH: When the COVID-19 pandemic hit, we were facing a time and a pandemic that our ASC and our entire healthcare system had never seen before. The challenges were beginning to pile up. Our center continued communication with local hospitals to ask what we could do to help, would we share our equipment and ventilators, would we share staff, did we need to close, how were we going to continue to care for our community, being able to offer safe, high quality care?
We wanted the flexibility to continue to do what we do best, outpatient surgery but also be able to free up the valuable hospital space needed to care for COVID-19 patients. When HWOW was released, we signed up as soon as we could and were one of the first ASCs that gained approval. The policy was announced on March 30, 2020, and the Centers for Medicare & Medicaid Services (CMS) has our participation start date as March 31, 2020.
Q: How difficult was it to get set up as a HWOW?
AH: The set up was slow at first, we were facing the unknown. It took a few weeks to get approval from our Medicare administrative contractor (MAC) and our state to participate. We were educating our MAC and the state about the program and asking questions about the attestation process, but ultimately there were no answers. We were in the unknown. The program has evolved since we signed up. They do have answers now and are allowing for additional flexibility.
Q: What types of cases were you able to perform as an HWOW participant that you could not perform as an ASC?
AH: We have been able to perform a few additional cases we were previously unable to for Medicare beneficiaries that we were performing safely and successfully for our commercial payers, such as removal of thyroid (60271) and repeat thyroid surgery (60260).
Q: What benefits did your participation in the HWOW program bring to your community?
AH: We have been able to consistently provide access to surgical care in our community. We are here and willing, and we are the backup in the event the hospital has a surge. Most importantly we are showing CMS what we can do.
Q: How easy/hard was it to get paid for the procedures you performed through the HWOW program?
AH: The first reimbursement took about three months. Submitting claims for HWOW is through Medicare Part A, which we are not used to doing as an ASC. We reached out to our MAC, Palmetto GBA, for guidance. We had challenges, for example, modifiers can only be placed on one line for bilateral procedures, not two lines. Pre-certification was required for cases we normally did not have to get pre-certification for, such as septoplasty. The key was to remain in contact and develop a rapport. Remember that your MAC is there to help. It was jumping through hoops and learning something new. We are lucky to have an amazing director of patient accounts who checked every detail and has finally found a little normalization in our reimbursements for HWOW.
Q: Were there any downsides to participation?
AH: It looks like the public health emergency will be extended through 2021. That will give us more time to keep ASCs in the spotlight and show CMS and our community what we do best: provide safe, high-quality care. At first, the downside was the unknown, but as ASCs, we are not afraid to try something new. We are good at what we do.
Q: What are the long-term benefits of participating in the HWOW program?
AH: This is our chance to advocate for change. We successfully perform procedures for commercial payers, and we can perform the same procedures for Medicare beneficiaries. Why not take the opportunity to show CMS what we can do?