REGULATORY REVIEW

Burden Reduction Rule Update

BY KARA NEWBURY | SEPTEMBER 2020

Almost a year has passed since the Centers for Medicare & Medicaid Services (CMS) released a final rule, but the guidance for implementing the changes in the rule are still pending.

Coronavirus Federal Legislative Roundup

BY STEVE SELDE | AUGUST 2020

Since the threat of the coronavirus came into sharper relief earlier this year, the federal government has taken many steps to support and provide regulatory flexibility to ASCs and other healthcare providers and shore up other sectors of the economy.

ONC Releases New Electronic Health Information Regulations

BY ALEX TAIRA | JUNE-JULY 2020

On March 9, 2020, the Office of the National Coordinator (ONC), the federal agency in charge of coordinating nationwide healthcare information technology, or health IT, published a long-awaited final rule: 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program or the Information Blocking Rule. Two of eight exceptions in the rule that would absolve a party from charges of information blocking might apply to ASCs.

Adding Procedures to the ASC-Payable List

BY KARA NEWBURY | MAY 2020

Advances in medical technology and changes in Medicare payment policy have expanded the list of procedures that the Centers for Medicare & Medicaid Services (CMS) will reimburse ASCs for providing to the program’s beneficiaries. ASCA has advocated for its members and urged CMS to add procedures to the ASC-payable list that can be performed safely on the Medicare population in the ASC setting.

CMS Policies that Impact ASC Payments

BY KARA NEWBURY | APRIL 2020

In the 2019 final payment rule for ASCs and hospital outpatient departments (HOPD), the Centers for Medicare & Medicaid Services (CMS) finalized its proposal to align the two entities’ update factors and moved ASCs to the hospital market basket, which has long been used to update HOPD payments. CMS plans to use the hospital market basket to update ASC payments for the five-year period of calendar year (CY) 2019 through CY 2023.

Attend ASCA 2020 Regulatory Sessions

BY ALEX TAIRA | MARCH 2020

Year-to-year changes in Medicare policy, accreditation and quality reporting can be difficult to keep up with, but failure to stay on top of these updates can mean painful financial penalties.

ASCA Advocacy Bears Fruit in 2020 Payment Rules

BY KARA NEWBURY AND ALEX TAIRA | FEBRUARY 2020

The Centers for Medicare & Medicaid Services (CMS) released its 2020 hospital outpatient prospective payment system (OPPS)/ASC final payment rule in November 2019. The rule finalizes the addition of eight codes, including total knee arthroplasty (TKA), to the ASC-payable list.

CMS Makes Significant Changes to ASC Conditions for Coverage

BY KARA NEWBURY | JANUARY 2020

On September 25, 2019, the Centers for Medicare & Medicaid Services (CMS) announced a final rule to relieve burden on healthcare providers by “removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare providers and suppliers.”

Trump Administration Works to Reduce Regulatory Burden

BY ALEX TAIRA | NOVEMBER-DECEMBER 2019

In September 2019, the Centers for Medicare & Medicaid Services (CMS) announced the finalization of burden reduction measures the ASC community has long requested: (1) removing the requirement that ASCs have a transfer agreement with a hospital or that all ASC physicians have admitting privileges with a local hospital, (2) replacing the requirement regarding history and physical assessment (H&P) with a new standard based on a clinician’s clinical judgment and (3) revisions to emergency preparedness requirements.

ASCQC Conference Shows Industry’s Continued Commitment to Quality

BY ALEX TAIRA | OCTOBER 2019

On July 22, the Ambulatory Surgery Center Quality Collaboration (ASCQC) held its sixth annual conference in Washington, DC. The meeting brought together a wide-ranging group of industry stakeholders, including representatives from facilities, physician groups, management companies, health information technology (IT) vendors, regulatory agencies, specialty societies, and accreditation and quality organizations.

Keep Your Next Building Project Compliant

BY ALEX TAIRA | SEPTEMBER 2019

The main regulatory guidance to consult when building or renovating an ASC comes from the Facility Guidelines Institute (FGI), an independent, not-for-profit organization dedicated to developing guidance for the planning, design and construction of hospitals, outpatient facilities and residential healthcare and support facilities.

History of Prescription Drug Regulation

BY ALEX TAIRA | AUGUST 2019

In an October 2018 poll conducted by the Kaiser Family Foundation (KFF), healthcare was the most important issue among registered voters, and healthcare costs, including prescription drugs, was listed as the most important issue within healthcare. A follow-up KFF poll conducted in March 2019 found that 79 percent of respondents viewed the costs of prescription drugs as unreasonable and showed broad bipartisan support for a number of drug-related reforms.

CMS, ONC Release New Regulations on EHI

BY ALEX TAIRA | JUNE-JULY 2019

On February 11, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) concurrently released two long-awaited federal regulations addressing health information technology (HIT). The two rules seek to ease the flow of healthcare information, both from provider to patient as well as between providers, and add to a continually expanding regulatory framework governing electronic health information (EHI).

Growing Medicare’s ASC-Payable List

BY KARA NEWBURY | MAY 2019

While advances in medical technology and changes in Medicare payment policy over the past four decades have expanded the list of procedures for which the Centers for Medicare & Medicaid Services (CMS) will reimburse ASCs, Medicare policies have not kept pace with innovation.

CMS Makes Changes to its Quality Reporting Program

BY KARA NEWBURY | APRIL 2019

The Centers for Medicare & Medicaid Services (CMS) made significant changes to Medicare’s ASC Quality Reporting (ASCQR) Program for 2019 and beyond, including the suspension of four outcomes measures that have been part of the ASCQR Program since its inception in 2012. Facilities that have been collecting and reporting data on Medicare claims forms are no longer required to do so for 2019.

Medicare’s Top Citations in 2018

BY KARA NEWBURY | MARCH 2019

The Centers for Medicare & Medicaid Services (CMS) conducted 1,185 health surveys and 819 life safety surveys at 5,772 CMS-certified facilities in 2018. A look at the top citations CMS issued during those surveys can help provide insight into what surveyors focused on and identify areas where facilities failed to comply.

Driving Quality in ASC Total Joint Procedures

BY ALEX TAIRA | FEBRUARY 2019

As technology and new techniques expand the possibilities for outpatient surgery, few procedures have been the focus of as much discussion as total joint replacements (TJR). The rise of these procedures—in demand, performance and overall spending— has been nothing short of meteoric.

CMS Proposes Changes to Conditions for Coverage

BY KARA NEWBURY | JANUARY 2019

In September 2018, the Centers for Medicare & Medicaid Services (CMS) announced “Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction” as part of a proposed rule that would revise the applicable Conditions of Participation (CoPs) that apply to providers and Conditions for Coverage (CfCs) that apply to ASCs.

Keep Your Patient Data Secure

BY ALEX TAIRA | NOVEMBER-DECEMBER 2018

The Information Age has revolutionized the health care industry, giving patients and providers greater, more specific access to personal health data. Care coordination operates with greater efficiency through the electronic transfer of personal health information (PHI), and providers and facilities can be reviewed on an expanded range of quality metrics.

ASCs Gain Significant Ground under Proposed Rule

BY KARA NEWBURY | OCTOBER 2018

The 2019 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Payment Rule that the Centers for Medicare & Medicaid Services (CMS) released at the end of July is the most positive for ASCs since 2009, when the ASC payment system was aligned with the hospital outpatient department (HOPD) payment system.

CMMI: Pursuing Innovation in Medicare and Medicaid

BY ALEX TAIRA | SEPTEMBER 2018

In March 2010, after more than a year of development, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). Of particular note was Part III, Sec. 3021, which created a new Center for Medicare & Medicaid Innovation (referred to as CMI in the bill, now commonly known as CMMI) within the larger Centers for Medicare & Medicaid Services (CMS).

Citation Trends in Emergency Preparedness

BY KARA NEWBURY | AUGUST 2018

Medicare-certified ASCs have been required to have a disaster preparedness plan since 2009. As noted in State Operations Manual Appendix L—Guidance for Surveyors: Ambulatory Surgical Centers, the intent was for an ASC to “have in place a disaster preparedness plan to care for patients, staff and other individuals who are on the ASC’s premises when a major disruptive event occurs.”

ASC Quality Reporting Program Requirements for 2019

BY KARA NEWBURY | JUNE-JULY 2018

With the ASC Quality Reporting (ASCQR) Program web-based measure deadline of May 15, 2018, in the rearview mirror, it is time to look ahead to the data that will be reported for the Centers for Medicare & Medicaid Services (CMS) ASCQR Program in 2019 for 2020 payment determinations. It also is a good time to review some of the publicly available data on current measures to determine where ASCs can improve.

The History and Regulation of EHRs

BY ALEX TAIRA | MAY 2018

In recent years, health information technology (HIT) has been the talk of the health care industry. Central to this discussion are products known as electronic health records (EHR), systems that electronically capture patient-provider encounter information, securely store the digital information and make it available for future reference. The potential benefits of such a system are boundless: streamlined provider workflows, increased information sharing across sites of service, reduction in medical errors, increased patient access to their health record, better medication tracking and more. Developing and implementing tailored, functional EHRs, however, has been a rocky road even for those with time and resources.

ASCA Takes Aim at Medicare Payment Policy

BY KARA NEWBURY | APRIL 2018

From survey and certification issues to quality reporting and physician payment issues, there is always something happening on the federal regulatory front. One of the primary areas of focus for ASCA regulatory staff is on Medicare payment policy issues, and advocacy efforts related to Medicare’s 2019 ASC payment rule are already underway.

Be Ahead of the Construction Curve

BY JENNIFER BUTTERFIELD, RN, CASC | MARCH 2018

Constructing or renovating a medical facility is expensive and complicated. Do not make the mistake of believing moving a wall is “no big deal,” and that a regular home builder is up to the task. When it comes to medical construction, consult an expert and get a copy of the 2018 Guidelines for Design and Construction of Outpatient Facilities by the Facility Guidelines Institute.

TKA Comes Off the Inpatient-Only List

BY KARA NEWBURY | FEBRUARY 2018

One of the most heavily discussed policy changes in the calendar year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) was the removal of total knee arthroplasty (TKA), CPT 27447, from Medicare’s inpatient-only (IPO) list as of January 1, 2018. While TKA is not on the ASC-payable list, its removal from the inpatient-only list is a positive step toward reimbursement in the ASC setting for fee-for-service Medicare patients.

CMS’ New Emergency Preparedness Requirements

BY KARA NEWBURY | JANUARY 2018

During the fall of 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule titled Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation became effective on November 16, 2016, and as of November 15, 2017, the 17 health care provider and supplier types that must comply with the rule, including ASCs, began being held to these revised standards during their Medicare surveys.

Make Compliance Easier

BY ALEX TAIRA | NOVEMBER-DECEMBER 2017

With Medicare’s 2018 payment rule in final form and the calendar refreshing toward a new year, now is a good time for ASCA members to consider how to make the most of all the regulatory resources ASCA makes available for their use each year. Navigating the assortment of rules and regulations tied to ASC oversight, payment and accreditation can be a complex proposition, even for those with experience.

Joint Replacement Front and Center in OPPS/ASC Proposed Rule

BY KARA NEWBURY | OCTOBER 2017

Advances in medical technology have expanded the types of patients who can be treated outside the hospital. Despite these advances, the Centers for Medicare & Medicaid Services’ (CMS) payment policies have traditionally lagged innovation, and many procedures, such as total joints, are currently on the inpatient-only (IPO) list.

MACRA Is Here

BY ALEX TAIRA | SEPTEMBER 2017

In last year’s November- December Focus magazine we outlined the Medicare Access and CHIP Reauthorization Act, commonly known as MACRA. This act, passed in 2015, instituted new mechanisms for Medicare physician payment, replacing the old Sustainable Growth Rate (SGR) formula. With the arrival of a new administration, as well as the June release of proposed updates, it seems worthwhile to reiterate MACRA’s overarching structure, highlight some new developments and give an indication of how it might affect clinicians operating in ASCs in the coming years.

Got OAS CAHPS Questions?

BY KARA NEWBURY | AUGUST 2017

In July, the Centers for Medicare & Medicaid Services (CMS) proposed to delay the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program for CY 2018 data collection in the 2018 Proposed Medicare Payment Rule. A lot of questions remain about the survey.

CPI-U and Secondary Rescaling

BY KARA NEWBURY | JUNE-JULY 2017

Beginning January 1, 2008, the Centers for Medicare & Medicaid Services (CMS) began paying ASCs for the facility services they provide to Medicare beneficiaries using a system that is linked primarily to the Hospital Outpatient Department (HOPD) payment system, also known as the Hospital Outpatient Prospective Payment System (OPPS).

Safeguarding PHI

BY NAWA ARSALA | MAY 2017

In 2016 alone, there were 329 Health Insurance Portability and Accountability Act of 1996 (HIPAA) breaches of protected health information (PHI) that affected 500 or more individuals. Two hundred and fifty-four of those breaches involved electronic protected health information (ePHI).

Patient Experience Survey Coming to ASCs

BY KARA NEWBURY | APRIL 2017

While many ASCs conduct their own patient satisfaction surveys, there is currently no single instrument that assesses patient experiences in outpatient surgical settings. This will change beginning next year when facilities will need to start using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) survey to meet ASC Quality Reporting (ASCQR) Program requirements.

Analyzing CMS’ Final Emergency Preparedness Rule

BY NAWA ARSALA | MARCH 2017

The Centers for Medicare & Medicaid Services (CMS) accommodated ASCA’s comments in several ways in its final rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The rule establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.

Medicare’s 2017 Final Payment Rule

BY KARA NEWBURY | FEBRUARY 2017

The Centers for Medicare & Medicaid Services (CMS) issued its final payment rule regulating 2017 ASC Medicare payments on November 1, 2016. Provisions in that rule went into effect January 1, 2017.

Massachusetts Proposes DoN

BY NAWA ARSALA | JANUARY 2017

Massachusetts has proposed a Determination of Need (DoN) regulation that would prohibit freestanding ASCs from applying for a DoN for any proposed project unless they are affiliated with or in a joint venture with an acute care hospital. The affiliation described in the proposed regulation broadly includes: capital expenditures, substantial change in service, original license, DoN-required service or DoN-required equipment. Massachusetts enacted a moratorium on DoNs for ASCs in 1994. Since then, the number of Medicare-certified ASCs in the state has decreased from 63 to 56. The proposed regulations would lift this moratorium, which prevented ASCs from applying for DoNs. This type of “controlled expansion” has been proposed only in Massachusetts. Moreover, ASCs in the state are the only stakeholders subject to such a restriction.

MACRA Is Just Around the Corner

BY SHEILA MADHANI | NOVEMBER-DECEMBER 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was hailed at the time of its enactment for repealing the Sustainable Growth Rate (SGR), the much maligned annual payment adjustment factor that perennially forced Congress to approve legislation to avoid steep, often double-digit cuts to Medicare physician payments. This new law profoundly alters how and how much physicians will be paid for services furnished to Medicare beneficiaries and how physicians will interact with the program. These changes are expected to alter payment and impose substantial new administrative obligations on physician groups and, potentially, realign the market for physician services. For ASCs, these changes present some new and unique challenges and opportunities.

Patient Experience Survey Coming to ASCs

BY KARA NEWBURY | OCTOBER 2016

ASCs pride themselves on the high-quality care they provide and the high level of satisfaction that their patients report. Patients appreciate the convenience of ASCs and the fact that performing only outpatient elective procedures better controls the environment and limits patient exposure to potential health care acquired infections.

Medicare Proposes Quality Reporting Changes

BY KARA NEWBURY | SEPTEMBER 2016

ASCs began reporting quality data to Medicare in 2012. There were five quality measures, all of which could be submitted on the claim forms that ASCs already submit to Medicare. Four years later, the number of measures in the ASC Quality Reporting (ASCQR) Program has more than doubled, and if the seven new measures referenced in the 2017 ASC proposed payment rule that are intended for inclusion starting in 2018 are finalized, the number will have almost quadrupled.

CMS Adopts 2012 Life Safety Code

BY KARA NEWBURY | AUGUST 2016

The Centers for Medicare & Medicaid Services (CMS) recently adopted. provisions of the 2012 editions of the Life Safety Code (LSC) (NFPA 101) and the Health Care Facilities Code (NFPA 99) in order to “simplify and modernize the construction and renovation process for affected health care providers and suppliers, reduce compliance-related burdens, and allow for more resources to be used for patient care.”

Serious Reportable Events

BY STEVEN SELDE | JUNE-JULY 2016

Today, “never events” are referred to by a variety of terms, including “adverse patient events,” “patient safety events,” “sentinel events” and “serious reportable events” (SRE). While there are minute differences in the definitions of these terms, they aim to capture injuries that are caused by avoidable errors while providing medical care. ASC clinicians and administrators are familiar and experienced with documenting and reporting these events, but state and federal legislation and regulations requiring they do so are relatively modern developments.

HIPAA Enforcement

BY STEVEN SELDE | MAY 2016

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its Breach Notification, Privacy, and Security Rules are well-known to health care providers and facility administrators. The lesser known Enforcement Rule contains provisions relating to investigations, hearings and penalties and takes effect when, despite a facility’s comprehensive and well-documented HIPAA compliance program, something goes wrong. Observing the Enforcement Rule process can provide valuable lessons as your ASC evaluates its HIPAA compliance program.

ASC Payment Rates

BY KARA NEWBURY | APRIL 2016

Chances are you already know that the Centers for Medicare and Medicaid Services (CMS) ties ASC reimbursement rates to its hospital outpatient department (HOPD) rates. Do you also know what goes into setting the HOPD rates, how ASC rates differ from HOPD rates and who advises CMS on how this payment system should look?

Data, Changes to Regulations Needed to Expand ASC-Payable List

BY KARA NEWBURY | MARCH 2016

Advances in medical technology have expanded the types of patients who can be treated outside the hospital. Despite these advances, the Centers for Medicare & Medicaid Services’ (CMS) payment policies often lag behind innovation, with many procedures—such as total joints—still on the inpatient-only list.

Medicare’s 2016 Final Payment Rule

BY KARA NEWBURY | FEBRUARY 2016

The Centers for Medicare & Medicaid Services (CMS) issued its final payment rule regulating 2016 ASC Medicare payments in late October last year. Provisions in that rule went into effect January 1, 2016.

On the Regulatory Side

BY KARA NEWBURY | JANUARY 2016

Trying to predict all of the regulatory requirements that may change for ASCs in 2016 would require clairvoyant abilities that most do not possess. It is possible, however, to look to proposed rules and language in the past to determine what might be coming our way in 2016.

Track the Latest Regulatory and Legislative News for ASCs

Visit ASCA's web site every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA's Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.

Regulatory Review

REGULATORY REVIEW

Track the Latest Regulatory and Legislative News for ASCs