ASCA News Digest (August 19, 2014)

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August 19, 2014





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ASCA Highlights


Attend ASCA's Fall Seminar, No Matter Your Role in the ASC

ASCA's 2014 Fall Seminar, October 9–11, in Scottsdale, AZ, is an in-depth seminar aimed at those seeking advanced content on ways to streamline your ASC's clinical and business operations. Pay-per-day registration allows you to choose the days that interest you most and ASCA members enjoy discounts and can save even more by registering through August 31. MORE
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Save the date for ASCA’s 2015 Winter Coding Seminar, January 22-24, 2015, in San Diego, to ensure that your ASC is prepared for 2015’s coding and billing changes. This two-and-a-half day conference is a "must" when it comes to learning best coding practices that assure you receive the reimbursements you have earned. MORE
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The digital edition of the September issue of ASC Focus is now available. Read the latest issue to learn how to use benchmarking to reduce costs and drive quality improvement, the secrets of successful inventory management, how to stay HIPAA-compliant and how to add social media to your ASC's marketing mix. MORE
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The ASCA Capitol Fly-In, September 9-10, is less than a month away. To date, 66 people have registered to attend the event. Speaking directly with your members of Congress is an opportunity to educate them on the high quality, lower cost alternative that ASCs provide and it is one of the most effective ways to ensure that ASCs remain a viable health care option. MORE
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One of the key changes in CMS' proposed payment rule for ASCs is the addition of 10 spine codes to the ASC-payable list. It is imperative that CMS hear from ASCs and specifically surgeons who perform these procedures regarding the inclusion of these codes. ASCA has created sample letters that address the inclusion of these codes on the ASC approved procedure list for 2015. Please take a moment to download a letter template, personalize it for your center and submit it to CMS online. All letters must be submitted by September 2, 2014. MORE
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We're here for you.
It's a simple concept, but how many partners answer your questions and help guide you in your quest to manage your revenue cycle? LaClaro is always here to answer questions, offer guidance, and make sure your team has the data it needs to make better decisions for your facility.



Simplify your business office operations. Surgical Notes is a nationwide provider of transcription, coding, and document management applications. The ASC industry’s largest management companies and roughly 20,000 healthcare providers trust Surgical Notes to provide customer-focused solutions that eliminate manual processes, streamline workflow, and accelerate the revenue cycle. Visit us at www.surgicalnotes.com or call 800-459-5616 today!

Resources to assist ASC operators in determining the potential impact of Medicare’s proposed 2015 payment changes are now available on ASCA’s web site. Two of the most popular documents are ASCA’s Medicare Rate Calculator, which shows the proposed national and local payment rates for 2015, and a comparison between proposed ASC and HOPD rates for 2015. MORE
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The Centers for Medicare & Medicaid Services (CMS) has released a new webcast introducing the “Road to 10” tool. The webcast covers the history of the International Classification of Diseases (ICD) and the benefits of ICD-10. This is the first in the new “Road to 10” webcast series. Five more webcasts will follow—all aimed at helping small practices get ready for ICD-10 by the October 1, 2015, compliance date. MORE
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Support Excellence in Your ASC
Register for ASCA’s 2014 Fall Seminar, October 9-11, in Scottsdale, AZ. Get innovative solutions and state-of-the-industry advice for improving clinical care, business office management, materials management and your ASC’s bottom line. Attend one, two or all three days of the seminar. Early registration discounts end August 31.



Earn Your Continuing Education Credits
Get the insider information and real-world solutions you need to navigate the regulatory and accreditation requirements, billing and coding changes and clinical and operational concerns you face in your ASC every day by signing up now for ASCA’s 2014 Webinar Series. ASCA members save $50 on each webinar.



Save the Date for ASCA 2015
Mark your calendar for next year’s annual meeting, May 13-16, 2015. ASCA 2015 will take place at the Orlando World Center Marriott Resort & Convention Center. The hotel, just five minutes from Disney World, boasts 10 restaurants/lounges, 18-hole championship golf, a rejuvenating spa and a dedicated children’s splash park.

Last week, ASCA representatives met with Karen DeSalvo, MD, the national coordinator for Health Information Technology. Among the topics discussed during the meeting were barriers to ASCs adopting electronic health records (EHRs) and the development of standards for a certification process for EHRs in the ASC setting. MORE
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Industry News


The Threat of Health Care Market Consolidation
National Review (08/12/14) Salam, Reihan

Chris Pope observes in a new report from the Heritage Foundation that the problem of monopoly pricing power in medical care has actually exacerbated since the implementation of the Affordable Care Act. Regulatory solutions to the problem of hospital consolidation, like more aggressive price controls, will fail, according to Pope, because they address the symptoms of hospital consolidation rather than the root causes. He cites business models, like ambulatory surgical centers, that specialize in certain procedures, that can help drive down costs. Pope highlights the role of Medicare, which reimburses general hospitals at far higher rates than more efficient ambulatory surgical centers and other independent medical providers. He concludes hospitals are effectively rewarded for underperforming and for spending excessively. In his critique of the Affordable Care Act, Pope points out that the government is trusting that hospitals will use revenue from high reimbursement rates to cross-subsidize other desirable services, even though hospitals have generally failed to do so in a coherent or cost-effective way.
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Foreign Hackers Hit Community Health Systems' Computer Network, Take Data on 4.5 Million Patients
Modern Healthcare (08/18/14) Kutscher, Beth

A leading hospital operator says Chinese hackers stole the personal data of about 4.5 million patients earlier this year. Community Health Systems, which runs 206 hospitals in 29 states, says data thieves made off with patient names, addresses, Social Security numbers, and other details. The hack likely took place in April or June, the company said, and did not include patient credit card or medical information. Law enforcement had previously warned the U.S. healthcare sector that its systems were vulnerable to attacks seeking intellectual property and patient data. Community Health Systems reported the hack in a regulatory filing, saying it has expelled the hackers' malware from its network and will notify patients and government agencies as required by law. Federal law enforcement agents are investigating the incident,
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More Physicians Using EHRs Than Before
U.S. Department of Health and Human Services (08/07/14)

Two studies published in the journal Health Affairs reveal that in 2013, nearly eight in 10 office-based physicians reported adopting some type of electronic health records (EHR) system. Forty-eight percent of all physicians had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009. However, the studies indicate that in 2013, health information exchange among physicians was relatively low, with 39 percent reporting they electronically share data with other providers, but only 14 percent electronically sharing data with ambulatory care providers or hospitals outside their organization. Just 10 percent of hospitals were providing patients with online access to view, download, and transmit information about their hospital admission.
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Is the Sunshine Act Website Repeating HealthCare.gov's Mistakes?
Modern Healthcare (08/13/14) Tahir, Darius

Comparisons are being made between the troubled rollout of the Open Payments Web site, which includes information on payments doctors receive from pharmaceutical companies and medical devicemakers, and the introduction of Healthcare.gov last fall. Just as consumers had trouble registering for Healthcare.gov after the site was launched, so too are doctors finding it difficult to register for Open Payments in order to check payment reports that have been made about them for accuracy. Doctors who have tried to register for Open Payments say the site requests information during the registration process that can take a long time to retrieve, though the site locks users out after 15 minutes of inactivity. At least one doctor reports being repeatedly kicked off Open Payments during the registration process, as well as instances in which the site was unresponsive. Part of the problem may be due to the fact that Open Payments is using a tool called EIDM to handle the first stage of the registration process. That tool was also used for the registration process for Healthcare.gov before it was removed from the site. The tool had been criticized for using a burdensome registration process. Registration for Open Payments has been suspended, though that move was made in response to a report that data for two doctors with the same name had been combined rather than the difficulties physicians are having with registration.
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A Multi-Institutional Analysis of 6749 Patients Using the 2011 NSQIP Database
Journal of Plastic Surgery and Hand Surgery (08/14) Vol. 48, No. 4, P. 270 Lim, S.; Jordan S.W.; Jain, U.; et al.

Very few large scale, multi-center studies have been conducted that assess unplanned re-operation in outpatient plastic surgery. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program to identify all plastic surgery outpatient cases performed in 2011. Of the 6,749 outpatient plastic surgery cases identified, there were 125 unplanned re-operations (UR). Regression analysis revealed that body mass index, preoperative open wound/wound infection, American Society of Anesthesiologists class 3, and total work relative value units were significantly predictive of UR. The presence of any complication also was significantly associated with UR. The researchers concluded that UR is a critical quality indicator for ambulatory plastic surgery facilities, and addressing risk factors will aid in surgical planning and risk adjustment.
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With Health Law, ERs Still Packed
Kaiser Health News (08/15/14) Calandra, Robert

Many health industry analysts thought if people bought health insurance through the Affordable Care Act, they would find a private doctor and stop using hospital emergency rooms for their primary care. However, an online study by the American College of Emergency Room Physicians found that nearly half of its members have seen a rise in visits since Jan. 1 when ACA coverage began. A resounding 86 percent of the physicians said they expect that number to continue growing. Complicating the matter is the growing shortage of primary care physicians. People who have never had a private doctor may have trouble finding one, so they continue to rely on emergency rooms.
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A Randomized, Prospective Analysis of an Innovative Strategy for Improving Patient Compliance with Preadmission Showering Protocol
Journal of the American College of Surgeons (08/14) Vol. 219, No. 2, P. 256 Edmiston Jr., Charles E.; Krepel, Candace J.; Edmiston, Sarah E.; et al.

Surgical site infections (SSIs) are associated with morbidity, mortality, and excessive use of health care resources. This study examines the benefit of using an electronic patient alert system (EAS) for increasing compliance with a preadmission antiseptic showering protocol using 4 percent chlorhexidine gluconate (CHG). Eighty volunteers were randomized to four CHG showering groups, and skin-surface concentrations of CHG were analyzed using colorimetric assay at five separate anatomic sites. The researchers found that mean composite CHG skin-surface concentrations were much higher in the groups prompted by the EAS than the non-EAS groups. This indicates that the EAS was effective in enhancing patient compliance with the showering protocol, although more standardization is needed to maximize patients' application of 4 percent CHG, according to the researchers.
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Ambulatory Spine Surgery: A Survey Study
Global Spine Journal (08/01/2014) Vol. 04, No. 3, P. 157 Baird, E.O.; Brietzke, S.C. ; Weinberg, A.D.; et al.

To assess current practices of spine surgeons performing ambulatory surgery in the United States, researchers conducted a cross-sectional study involving members of the International Society for the Advancement of Spine Surgery. Overall, 84.2 percent of respondents said they performed some type of ambulatory spine surgery, and 49.1 percent were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors. Surgeons in private practice were more likely to perform ambulatory surgery, and nonacademic surgeons were both more likely to invest in ambulatory surgery centers and perform surgery at least part of the time in a surgery center.
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Comparison of Acquisition Costs of Surgical Supplies in Different Health Care Systems for Cataract and Glaucoma Procedures
Journal of Glaucoma (08/14) Vol. 23, No. 6, P. 355 Valentine, J.; Zurakowski, D.; Ayyala, R.S.

Researchers conducted a nonrandomized, comparative, and cross-sectional study to determine cost identification of surgical supplies for performing cataract and glaucoma procedures. The study included two ambulatory surgical centers (ASCs), two Veterans Affairs Medical Centers, a state-run charity hospital, and a private university hospital. A list of input prices for disposable surgical items needed for phacoemulsification with intraocular lens and for trabeculectomy with mitomycin-C, Ex-PRESS shunt placement, and Ahmed glaucoma valve (AGV) with scleral patch graft was administered to six facilities. The ASC system had the lowest cost for both Ex-PRESS shunt ($707) and AGV ($865), whereas the university ($1,352 for the Ex-PRESS) and the state ($1,338 for AGV) had the highest cost. Among the 3 glaucoma procedures compared, trabeculectomy has the lowest acquisition costs for disposable items.
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Low Rate of Large Polyps (>9 mm) Within 10 Years After an Adequate Baseline Colonoscopy With No Polyps
Gastroenterology (08/14) Vol. 147, No. 2, P. 343 Lieberman, David A.; Holub, Jennifer L.; Morris, Cynthia D.; et al.

Colonoscopy screenings are recommended every 10 years for average-risk individuals, but many patients are examined at shorter intervals. Investigators gathered data from 69 gastroenterology centers using the National Endoscopic Database, and found that no polyps were present in 147,375 patients during a baseline colonoscopy, of whom 17,525 had a follow-up colonoscopy within fewer than 10 years. The most common reason for repeating the examination within 1 year was that the first was compromised by inadequate bowel preparation or incomplete examination. Reasons for reexaminations within 1–5 years included average-risk screening (15.7 percent), family history of colon polyps or cancer (30.1 percent), bleeding (31.2 percent), gastrointestinal symptoms (11.8 percent), or a positive result from a fecal blood test (5.5 percent). The investigators concluded that repeat colonoscopies within less than 10 years are of little benefit to patients who had adequate examinations and were found to have no polyps, but were beneficial to patients whose baseline examination was compromised.
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From the Payer, Patient, and Societal Perspectives in the United States
JAMA Ophthalmology (07/17/2014) Neel, S.T.

This study evaluates the cost difference between delayed sequential cataract surgery (DSCS) and immediate sequential cataract surgery (ISCS) in the United States for patients covered by Medicare. Investigators compared cataract surgery volume and eligibility estimates, 2012 Medicare reimbursement schedules, and actual or estimated patient cost data for the West Tennessee region and nationally for DSCS and ISCS. Ambulatory surgery center and hospital outpatient department setting costs were evaluated. A switch from DSCS to ISCS in 2012 resulted in a West Tennessee Medicare patient seeing his costs reduced by $174 for direct medical costs, $40 for travel costs, and $138 for lost wages. Investigators say payers and patients would benefit from an economic standpoint by switching from DSCS to ISCS, although more research is needed to assess the effect of switching to ISCS from physician and surgical facility perspectives.
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Predictors of Readmission After Outpatient Otolaryngologic Surgery
The Laryngoscope (08/01/2014) Vol. 124, No. 8, P. 1783 Jain, Umang; Chandra, Rakesh K.; Smith, Stephanie S.; et al.

There is currently a lack of data on readmission rates for otolaryngological surgery. To identify potential benchmark data on causes and predictors of readmission following outpatient otolaryngological surgery, a retrospective analysis of the 2011 National Surgical Quality Improvement Program (NSQIP) dataset was conducted. Researchers reviewed the NSQIP for outpatients with "Otolaryngology (ENT)" as their recorded surgical specialty, finding a total of 6,788 outpatients. The unplanned readmission rate was 2.01 percent. Multivariate regression analysis revealed superficial surgical site infection and work relative value units (RVUs) were key positive and negative risk factors, respectively, for readmission.
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Surgery Partners to Buy Honolulu Spine Center for $5.82M
Pacific Business News (08/04/14) Tuohy, Matt

Surgery Partners hopes to acquire the Honolulu Spine Center in Honolulu, Hawaii, for $5.82 million in September as part of a nationwide merger with Symbion ARC Management Service. The larger $792 million merger will make Surgery Partners one of the largest ambulatory surgery center operators in the United States. The Honolulu Spine Center is a 7,800-square-foot center featuring two operating rooms and a private recovery room. The center offers hand surgeries, spine surgeries, pain management and intervention, and orthopedics. The change in ownership is subject to government approval before the acquisition can be made, and is currently in the approval process by the Hawaii State Health Planning and Development Agency. No changes to services or staffing are expected, according to the certificate of need.
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