REGULATORY REVIEW
BY KARA NEWBURY | JANUARY 2021
On April 1, 2020, ASCA sent letters to the US Department of Treasury and the Small Business Administration urging ASCs to be eligible for Paycheck Protection Program (PPP) loans, as many ASCs did not meet the affiliation rules, due to relationships with corporate management companies or hospital partners.
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BY KARA NEWBURY | NOVEMBER-DECEMBER 2020
On February 27, 2020, ASCA staff advocated for payment policy changes with senior level executives with the Centers for Medicare & Medicaid Services (CMS) at the US Department of Health and Human Services (HHS) offices in Washington, DC. Just two months into the new year, this ended up being our last “routine” meeting for 2020—the last one that did not center around the 2019 novel coronavirus (COVID-19).
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BY KARA NEWBURY | OCTOBER 2020
A question that ASCA staff get commonly is how does the Centers for Medicare & Medicaid Services (CMS) reimburse for devices?
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.”
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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.
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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.
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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.
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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.
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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).
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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.”
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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).
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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).
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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.
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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.
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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.
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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.
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