ASCA News Digest (April 15, 2014)

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April 15, 2014





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  •  Free White Paper: 10 reasons why ASCs nationwide are implementing an EMR.
  • "To get the maximum benefits, you need to switch to an EMR specifically designed for an ASC" - Anne Dean, The ADA Group. Learn why in this Q&A.
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  • "Growth of 23-Hour Stay Programs for Ambulatory Surgery Centers" - Read the article.
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ASCA Highlights


Out-of-Network Billing: Is This Still a Viable Business Strategy for ASCs?

In today’s health care environment, many ASC industry leaders question if accepting out-of-network cases is a good strategy for long-term financial success. Learn about the impact that out-of-network billing can have on your ASC’s revenue cycle as well as best practice procedures for optimizing collection results during ASCA’s next webinar on Tuesday, April 22 at 1:00 pm ET. MORE
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Faster payments. Lower costs.

With ASC Billing Services from SourceMedical, your facility receives payments faster—by an average of over 20 percent—and reduces internal costs. Find out why Modern Healthcare ranked SourceMedical among the largest revenue cycle management companies in 2013. Learn more at http://sourcemed.net/asc-billing-services .



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As a part of the HHS National Action Plan to Prevent Healthcare Associated Infections, the Agency for Healthcare Research and Quality (AHRQ) is funding a series of 12-month patient safety improvement programs for ambulatory surgery centers. To date, two cohorts of ambulatory surgery centers and hospital outpatient departments have signed up to participate. MORE
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ASCA is pleased to announce that US Representative Diane Black (R-TN) will speak at the ASCA 2014 Closing Session in Nashville on Saturday, May 17. Rep. Black has led the charge on electronic health record issues for ASCA and the physician community and is the sponsor of the Electronic Health Records Improvement Act of 2013 (H.R. 1331). Register today for ASCA 2014, May 14–17 in Nashville. MORE
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ASCA 2014’s Exhibit Hall—the largest and most diverse in the industry—features more than 180 dynamic companies and unparalleled opportunities to find exactly the products and services your ASC needs in 2014 and beyond. Win a $500 cash prize as you explore the Exhibit Hall using the ASCA 2014 Exhibit Hall Passport. Attendees can also receive prizes for wearing the ASCA 2014 Pedometer. MORE
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The data collection period for the first quarter of 2014 (Q1) will close in two weeks on April 30. Start submitting your data now. If you haven’t purchased your 2014 subscription yet, you still have time to sign up. Unlike last year, we will not be offering pro-rated pricing for subscribing after the first quarter’s data collection closes. Sign up today. MORE
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The Centers for Disease Control and Prevention (CDC) has released the Operational Guidance for ASCs in order to assist in the collection and reporting of quality measure ASC-8, Influenza Vaccination Coverage Among Health Care Personnel, as part of Medicare’s ASC Quality Reporting Program. The data will be reported to the CDC’s National Healthcare Safety Network (NHSN). MORE
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Industry News


Medicare Drug Costs Looming Ever Larger
Washington Post (04/10/14) Whoriskey, Peter; Keating, Dan; Sun, Lena H.

The release of data on Medicare payments made to doctors is raising questions about the extent to which drug costs are driving the cost of running the government health program ever higher. The data showed that $8.6 billion of the $64 billion Medicare paid to doctors in 2012 was used to cover drugs--a figure that has been rising for a number of years. The Pharmaceutical Research and Manufacturers of America says it does not believe that the cost of prescription drugs is making a significant contribution to the nation's health care expenses. However, a number of doctors who have submitted multi-million dollar Medicare claims have blamed what they say are high drug prices, adding that drug companies are taking most of the money Medicare pays out.
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Doctor-Pay Trove Shows Limits of Medicare Billing Data
Wall Street Journal (04/09/14) Weaver, Christopher; Beck, Melinda; Winslow, Ron

Medical organizations and policymakers say there are limits to the usefulness of the Medicare billing data that was released by the Centers for Medicare and Medicaid Services (CMS) on April 9. That data includes information about how doctors are reimbursed for procedures performed on Medicare beneficiaries, but there are no details that could help someone looking at the data differentiate between a doctor who is engaging in Medicare fraud and one who is billing Medicare large amounts of money for legitimate reasons. For example, some doctors may need to bill Medicare large sums of money because they are including services performed by other healthcare providers in their claims. Other doctors may be specialists who have high-overhead costs, which are also reimbursable by Medicare, that drive up their billing amounts. Because the data released lacks information that can help put billing amounts into context, doctors have had to take steps to defend and explain their Medicare billing practices.
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Sebelius: Health Care Launch 'Terribly Flawed'
Associated Press (04/14/14) Elliott, Philip

Outgoing Health and Human Services Secretary Kathleen Sebelius said Sunday that the timeline for having ready the new health care law's online sign-up system "was just flat out wrong." She acknowledged that the launch of the HealthCare.gov Web site was very difficult and flawed. Still, Sebelius defended the impact of the health care law, noting that "people have competitive choices and real information for the first time ever in this insurance market." Sebelius' resignation comes just a week after enrollment for Obamacare ended. Approximately 7.5 million people have enrolled in the program.
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Patient-as-Observer Approach: An Alternative Method for Hand Hygiene Auditing in an Ambulatory Care Setting
American Journal of Infection Control (04/01/2014) Vol. 42, No. 4, P. 439 Le-Abuyen, Sheila; Ng, Jessica; Kim, Susie; et al.

Patients who observe the hand-hygiene compliance of their health care providers are educated and empowered to be more active in their own health care, according to new research. A survey pilot asked patients to observe their providers' hand-hygiene compliance, and the findings were used to motivate compliance among providers. Overall, patients observed approximately 97 percent compliance among their providers. Ambulatory-care clinics could consider using this "patient-as-observer" approach as a suitable alternative to hand-hygiene auditing, the researchers said.
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Little Progress Made in Cutting Down Surgical Wait Times
Montreal Gazette (Canada) (04/11/14) Derfel, Aaron

In Montreal, about 29 percent of residents in need of elective surgery must wait at least six months to get their procedures done. Despite efforts by the provincial government to reduce wait times, 10,675 people in Montreal had been waiting six months or more for an elective surgical procedure as of March 8, compared to just over 10,000 in 2008. Government data shows that the longest wait times were for bariatric surgery, while the shortest times were for cataract surgery. In addition, 31 percent of the city's residents who are awaiting same-day surgery have been waiting six months or more, while 29 percent of those waiting for in-patient surgery have been waiting half a year or more. Some surgeons note that they routinely treat patients who come into the city from other areas, so this increases the rates for Montreal compared to other cities.
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State Votes Down Kaleida Ambulatory Surgery Center
Buffalo Business First (04/10/14) Drury, Tracey

A planned ambulatory surgery center in Orchard Park, N.Y., was voted down by a panel of state health officials on April 10. The proposed Southtowns Ambulatory Surgery Center was a collaboration between Kaleida Health, 22 surgeons, and the University at Buffalo School of Medicine & Biomedical Sciences. Opponents of the $2.7 million multi-specialty center--including Catholic Health and two other independent hospitals--expressed concern that the facility would make worse an ongoing problem of overcapacity at existing surgery centers within area hospitals, lower access for the poor, and cause some area hospitals to lose millions in revenue. Supporters noted that the project met all the statutory requirements for need and that competitiveness issues should not be a part of the decision. A Kaleida spokesman said they plan to appeal.
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Eye Doctors Say Their Profits Are Smaller Than Data Makes Them Look
New York Times (04/10/14) P. B1 Pollack, Andrew; Abelson, Reed

Ophthalmologists received more Medicare money in 2012 than any other specialists, accounting for $5.6 billion in provider reimbursements, according to newly released Medicare data. However, ophthalmologists argue that their high representation among recipients is misleading and that much of their reimbursements go to the cost of drugs they administer in their offices. The most expensive drug, Lucentis, accounted for about $1 billion in Medicare spending in 2012, data from the Centers for Medicare and Medicaid Services show. The drug, used to treat retinal diseases such as macular degeneration, costs nearly $2,000 per injection. Many cancer specialists are also highly reimbursed for chemotherapy drugs. Eye doctors also point out that they treat mainly older patients, and therefore would be heavily represented in a payment system for older Americans.
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Medicare Agency Says Payments to Insurers Will Rise in 2015
Wall Street Journal (04/08/14) P. A5 Mathews, Anna Wilde; Peterson, Kristina

On April 7, federal regulators said they have expanded planned payments to insurers that operate private Medicare Advantage plans, with final rates higher than the cuts regulators proposed in February. Officials at the Centers for Medicare and Medicaid Services said the final rates for 2015 payments for the Medicare Advantage plans represent a 0.4 percent increase to insurers compared with this year, which is higher than the earlier proposal's 1.9 percent cut. Nearly 16 million people are now enrolled in Medicare Advantage plans, comprising 30 percent of all eligible beneficiaries, according to Stifel Financial Corp's Thomas Carroll. Medicare beneficiaries have the option of choosing the private Medicare Advantage plans that are offered by insurers paid by the federal government or staying with standard Medicare.
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Problems Paying Medical Bills: Early Release of Estimates From the National Health Interview Survey, January 2011-June 2013
CDC News Release (04/08/14) Cohen, Robin A.; Kirzinger, Whitney K.

Many U.S. patients under age 65 struggle to pay medical bills, but the proportion of those who have trouble appears to be declining. According to the Centers for Disease Control and Prevention's National Center for Health Statistics, data from the first six months of 2011 and the first six months of 2013 show that the percentage of persons in this age group who were in families that had problems paying medical bills fell from 21.7 percent to 19.8 percent. Children 17 and under were more likely than adults to be in families that had trouble paying medical bills, but that percentage fell from 23.7 percent in 2011 to 21.3 percent in 2013. Females in general were more likely than males to be in a family that had problems paying medical bills.
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Adenoma Detection Rate and Risk of Colorectal Cancer and Death
New England Journal of Medicine (04/03/14) Vol. 370, No. 4, P. 1298 Corley, Douglas A.; Jensen, Christopher D.; Marks, Amy R.; et al.

For every 1 percent increase in the detection rate of adenoma during colonoscopy, there is a 3 percent decrease in the risk of cancer. Researchers evaluated more than 314,000 colonoscopies performed by 136 gastroenterologists, with adenoma detection rates ranging from 7.4 percent to 52.5 percent. The adenoma detection rate was associated with lower risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52, 0.43 for advanced-stage interval cancer, and 0.38 for fatal interval cancer.
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Medicare Billing Problems: Coding Mistakes to Watch Out For
Medical Economics (04/08/14) Stantz, Renee

There are a number of coding errors that physicians' practices need to avoid when billing Medicare to ensure that they are being properly reimbursed. For example, using the wrong code for a surgery, utilizing a lower level of Evaluation and Management (E/M) than what is supported by documentation, and billing for an established--rather than a new--patient E/M can all lead to underpayments for submitted claims. Doctors' practices should also be on the lookout for unbundling, in which claims for different tests and treatments provided to patients are submitted to Medicare separately. Finally, physicians' practices should be sure to properly code claims for magnetic resonance imaging (MRI) scans to show that these procedures are being performed because they are medically necessary as defined by local coverage determinations.
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Providence Medical Center in Spokane Valley Nearly Ready for Patients
Spokesman-Review (04/12/14) Sowa, Tom

Providence Health Care's outpatient surgery center and medical clinic is set to open in Washington's Spokane Valley on April 28. The $44 million center will provide a number of outpatient services, including surgeries, diagnostic imaging, and neurologic and cardiology procedures. Providence Medical Park Spokane Valley has four surgical suites as well as three procedure rooms for colonoscopies and services by gastroenterologists. The center will also include urgent care and pediatric and family health care.
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Lee Memorial Plans 'Hospital Without Beds'
Florida Weekly (04/10/2014) Miller, Glenn

In its efforts to build a facility in Estero, Fla., Lee Memorial Health System has moved on to its second plan after the first plan was dismissed by state regulators. Lee Memorial President Jim Nathan called the new project "an exciting, new ambulatory care model that brings a critical mass of services and physician specialties into 'one destination health care center.'" Unlike the original plan to build an $81 million hospital, the new facility does not need approval from the Florida Agency for Health Care Administration. A spokesperson for the project called it "a hospital, but without beds."
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