ASCA News Digest (Jan. 7, 2014)

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CMS Announces Three Month Data Collection Delay for New Measures

The Centers for Medicare & Medicaid Services (CMS) has announced that it will delay data collection until April 1, 2014, for the three new quality measures that were recently finalized for inclusion in the Ambulatory Surgical Center Quality Reporting (ASCQR) Program.
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New Quality Measures Specifications Manual Released

CMS have posted an addendum to the ASC Quality Reporting Specifications Manual. Version 3.0a is effective for implementation beginning January 1, 2014, and continuing through December 31, 2014. The manual was updated to reflect changes made to the ASCQR program in the 2014 ASC Final Payment Rule.
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ASCA Webinar: Rules and Best Practices for Immediate-Use Steam Sterilization

Immediate-use steam sterilization (IUSS), often referred to as flash sterilization, has become a major issue of concern in ASCs. IUSS is a very complex process that requires precise adherence to each step in the sterilization process. ASCA's next webinar, Tuesday, January 28, at 1:00 pm ET, will address professional recommendations and measures that your ASC can take to ensure the appropriate use and success of IUSS.
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New ASCA Resource to Help Clarify Physician Meaningful Use Requirements

ASCA has added a frequently asked questions page on our web site to address concerns that ASCs have raised regarding implementation of Certified Electronic Health Record Technology (CEHRT).
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From ASC Focus: Auditing Your Business for Success

Just the word audit can be enough to send shivers down the spines of even the toughest of us. An audit, however, is an important concept in developing your business and one of the keys to success in understanding and tracking your business growth.
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CMS Webinar Reviews Updates to the Quality Reporting Program

CMS quality reporting staff provided some information in a webinar last month that clarified the new quality reporting requirements finalized in the 2014 ASC final payment rule.
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Government Affairs Update: Medicare Sequestration Cuts Extended in Budget Agreement
In a budget agreement reached last month, negotiated by US Representative Paul Ryan (R-WI) and US Senator Patty Murray (D-WA), both sides agreed to extend sequestration cuts aimed at Medicare providers until 2023. The cuts, which were originally set to expire in 2021, reduce the portion Medicare pays providers by two percent. The patient responsibility is not impacted by sequestration.
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Industry News

Emergency Visits Seen Increasing With Health Law
The New York Times (01/03/14) P. A1 Tavernise, Sabrina

Although proponents of the Affordable Care Act anticipated a reduction in emergency room (ER) visits by expanding Medicaid coverage, as low-income people would see primary care physicians instead, a study in the journal Science reveals that the newly insured actually visited the ER more often. The study compared around 30,000 low-income Portland, Ore., residents offered Medicaid through a 2008 lottery to those who remained uninsured, and researchers determined that during their first 18 months of coverage, the newly insured made 40 percent more ER visits than those without insurance. The pattern held across most demographic groups, times of day, and even for conditions treatable in primary care settings. The study authors say Medicaid reduces out-of-pocket costs for ER visits, and people tend to use services more often as costs decline. The study indicates that at least in the short term, ERs will face increased pressure as the number of insured individuals rises.
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Health Care Changes to Watch for in 2014
USA Today (01/01/14) Kennedy, Kelly

The Affordable Care Act took effect on January 1, allowing millions of uninsured Americans to obtain health coverage. Analysts are expecting several changes impacting health care this year, such as increased transparency in the pricing of health services. The law requires insurers to inform customers how much they are estimated to pay in out-of-pocket costs, and some states are requiring health care providers to list prices for treatments, says Ceci Connolly, managing director of PWC's Health Research Institute. The implementation of electronic records will likely increase in 2014 and trigger industry-wide change, forecasts Rainu Kaushal, chairwoman of the new Department of Healthcare Policy and Research at Weill Cornell Medical College. This is partly because more physicians will be required to use the records to participate in Medicare, which should lead to higher quality and efficiency, she says. Ray Scheppach, project director for the Health Care Cost Containment Commission, predicts that Medicaid administrators could move away from fee-for-service models to accountable care organizations and medical homes, where payment is based on low-cost, quality-outcome methods.
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Communication Counts When Preventing Retained Surgical Items
General Surgery News (12/31/13) Vol. 40, No. 12 Guarino, Ben

Occasionally, objects are unintentionally left behind in patients following surgery, but the exact number of such instances is uncertain because reporting them to the Joint Commission is chiefly voluntary. An alert from the Joint Commission urges hospitals to establish standardized counting systems to decrease the likelihood of retained items. Stanislaw P. Stawicki in the Department of Trauma and Critical Care at Ohio State University also encourages having an extra set of eyes. The presence of a surgical trainee, for instance, was associated with a roughly 70 percent reduction in risk for retained items, according to a 2013 study. A similar improvement can be achieved by a change of culture in the operating room, such as encouraging perioperative staff to halt procedures if a surgeon may have forgotten to look for a potentially retained item. Radio-tagged sponges and other tools also may curb the retention of surgical items, but they should not be a replacement for counting, the Joint Commission said.
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Medicare Pricing Drives High Health Care Costs
Washington Post (12/31/13) Whoriskey, Peter; Keating, Dan

Several recent studies have found that the prices Medicare sets for health care procedures and services have a significant effect on the cost of health care for Americans not enrolled in the government health care program. In one study, researchers at the University of California at San Diego analyzed millions of claims to identify a possible relationship between changes in the amount of money Medicare paid for a procedure or service and subsequent changes in the amount private insurers paid. The study found that private insurers tended to follow Medicare's pricing scheme, even when the program paid more than what was necessary for certain procedures and services. Another study, from the University of British Columbia, found that a $1 change in the amount Medicare pays for a procedure or service results in a $1.30 change in what private insurers pay. Researchers theorize that Medicare has a significant effect on the prices private insurers pay for procedures and services because the money the program pays out comprises more than one-fifth of the amount spent on personal health care, and because private insurers save money by following Medicare's price-setting decisions. But because those decisions are sometimes erroneous, private insurers may be spending more than what is necessary on health care procedures and services.
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New Technology at Cape Regional's Same Day Surgery Center
Cape May County Herald (NJ) (12/31/13)

New endoscopy equipment at the Cape Regional Medical Center is providing greater visualization, control, and workflow at the New Jersey facility's Same Day Care Center. Anthony Masciarelli, D.O., board-certified gastroenterologist at Cape Regional Physicians Associates notes that the technology "facilitates more accurate diagnosis and treatment, simplifies setup, improves workflow, and links patient and department information to the Medical Center's information network." In addition, says Dr. Renjy Vattasseril, the equipment enables tight control of the endoscope for close-up views, while advanced imaging offers exceptional clarity.
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Why More Boomers Are Getting Cataract Surgery at a Younger Age
Today.com (12/26/13) Kim, Eun Kyung

An increasing number of people are having cataract surgery--and are doing so at "younger" ages. A recent study by the Mayo Clinic found that about 20 percent of those surgeries done from 2005 to 2011 in Minnesota's Olmsted County were in patients younger than 65. By age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the National Institutes of Health's National Eye Institute.
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Extra Consultations Before Cataract Surgery Rise
Reuters Health (12/26/13) Jegtvig, Shereen

Extra doctor consultations before cataract surgery are on the rise, though there is no clear medical reason for the added costs. "The preoperative medical consultation is an understudied area. It's an intervention that we spend several billion dollars on each year in this country. We know surprisingly little about the process," says Dr. Stephen Thilen, an assistant professor of anesthesiology and pain medicine at the University of Washington who led a study of Medicare claims on the issue. Patients awaiting cataract surgery generally see the ophthalmologist who performs the surgery and the anesthesiologist or anesthetist if one is needed. Thilen's team looked at trends in additional preoperative consultations with the patient's family doctor, cardiologist, pulmonologist, or other physicians not directly involved in the surgery.
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2014 Coding Changes Bring Cuts and System Re-Design
Diagnostic Imaging (12/26/13) Howell, Whitney

Changes to the coding system are coming in 2014, likely prompting medical providers to tighten their belts. Implementation of the new ICD-10 coding system go into effect Oct. 1, and will expand the current 14,000-code ICD-9 system to 69,000 codes, requiring providers and referring physicians to be more specific with their diagnoses and documentation. There are also several coding changes before October. In the final rule, CMS mandated cuts to breast biopsy codes, as well as various CT and MRI studies. The most substantial reduction affects the breast imaging codes. Providers can expect anywhere between a 29 percent and 50 percent reduction for these codes, mostly as a result of bundling. Meanwhile, in a break from the past few years, CMS opted not to implement any further multiple procedure payment reductions. The cuts have applied to imaging services rendered by the same physician to the same patient during the same encounter.
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Local Surgery Center Inspires Legislation
Portland Tribune (OR) (12/25/13) Spitaleri, Ellen

Sen. Jeff Merkley (D-Ore.) visited the Eye Health Eastside Surgery Center in Clackamas, Ore., on Dec. 2 to see how an ambulatory surgery center operates because, he said, "a lot of people rely on them, and it was good see the full-service medical, surgical, and routine vision care they provide to children, adults, and seniors." ASC Director Cherie Shevlin says Merkley's visit, and his subsequent support for the Clackamas ASC, is significant because he is a co-sponsor of the Quality and Access Act of 2013 that will address the disparity in funding for patients receiving the same services in an ASC as opposed to a hospital.
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Medicare Monitoring Hip, Knee Surgeries
Cincinnati Enquirer (12/19/13)

Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals nationwide where elderly patients were more likely to suffer significant setbacks, as well as 97 hospitals where patients tended to have the smoothest recoveries. The effort marks the first time Medicare has rated hospitals' performance on two common elective procedures. Medicare plans to add hip and knee readmission rates to the criteria it uses when deciding whether to penalize hospitals each year.
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Study Shows Health Care Workers' Hands Contaminated With C. Difficile After Routine Care
Infection Control Today (12/17/13)

Almost one in four health care workers' hands were contaminated with Clostridium difficile spores after routine care of patients infected with the bacteria, according to a new study from the Society for Healthcare Epidemiology of America. "This is the first known study focusing on the carriage of viable C. difficile spores on health care workers hands," says Caroline Landelle, PharmD, PhD, lead author of the study. "Because C. difficile spores are so resistant and persistent to disinfection, glove use is not an absolute barrier against the contamination of health care workers' hands. Effective hand hygiene should be performed, even in non-outbreak settings."
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