ASCA News Digest (July 1, 2014)

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July 1, 2014





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ASCA Highlights


Registration Now Open for ASCA's 2014 Fall Seminar

Register now for ASCA’s 2014 Fall Seminar, which will take place October 9–11, 2014, at the Talking Stick Resort—a Four-Diamond resort in Scottsdale, Arizona. ASCA members enjoy a discounted registration fee and can save even more by registering before August 31. The 2014 Fall Seminar will offer educational sessions on key topics that drive development and daily operations at your ASC as well as the CASC Review Course and Exam. MORE


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ASCA has added a new webinar to its 2014 lineup that will serve as an introduction to Electronic Health Records. The webinar will take place Thursday, July 10, at 1:00 pm ET and will be offered free of charge to ASCA members ($50 for nonmembers). Attendees will learn current regulatory and industry requirements, what you should look for in an EHR, what you should be discussing with your physicians and how you can start preparing your ASC. MORE
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The data collection period for the second quarter (Q2) of the 2014 ASCA Benchmarking Program is now open. The collection period will close July 31. If you haven’t purchased your 2014 subscription yet, there is still time to sign up. ASCA Benchmarking features some significant improvements for the 2014 program, including an Executive Summary section, new survey questions and enhanced help capabilities. MORE
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ASCA's Medicare Rate Calculator shows your national and local payment rates for 2014. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest. The new calculator has been updated to include code 0356T, which became payable in July 2014. MORE
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CMS posted another addendum to the ASC Quality Reporting (ASCQR) Specifications Manual. The most substantial change is that code V13.89 is being removed from measures ASC-9 and ASC-10 because it is non-specific for history for colonic polyps. MORE
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Ensuring Patient Safety with Capnography
The RespSense™ and LifeSense® capnography monitors are simple-to-use, cost-effective tools that help you ensure your patients are adequately ventilated during sedated dental procedures. The monitors provide continuous and reliable monitoring to help identify potentially life-threatening ventilation status changes such as respiratory depression during dental procedures on sedated patients.



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!

Planning has begun for ASCA 2015 to be held in Orlando, May 13–16, 2015. Your ideas for session topics and speakers are an invaluable part of determining the exceptional educational content that the meeting provides every year. Submissions for ASCA 2014 will be accepted through July 31, 2014. MORE
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CMS is currently accepting the Eligible Professional 2015 Hardship Exception Application for eligible providers who are seeking a hardship exception to the electronic health records (EHR) meaningful use requirements for the 2013 reporting year. Applications must be submitted by tomorrow. If approved, the exception is valid for one year. MORE
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USPO Job Post   Clinical Director Opening
USPI is seeking a Clinical Director for The Center for Ambulatory Surgical Treatment in Westwood, CA. Will direct all aspects of the clinical functions, processes and staff. Requires a Bachelor's Degree in Nursing or (Nursing or Master’s degree a plus.) Minimum three years management experience in the health field required.  Apply at www.unitedsurgicalcareers.com or FAX 972-692-8099.  EOE.

The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Wednesday, July 23, to discuss the new ASC Quality Reporting Program requirements released in the 2015 ASC Proposed Payment Rule. The webinar will be presented by CMS Government Task Leader Anita Bhatia, PhD, MPH, and will be offered at 10:00 a.m. and 2:00 p.m. ET. MORE
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Since last Wednesday’s Capitol Fly-In, nine cosponsors have been added to pro-ASC legislation, including the ASC Quality & Access Act and the Removing Barriers to Colorectal Cancer Screening Act. 88 ASCA members from 21 states directly lobbied their members of Congress and congressional staff successfully as part of ASCA’s 2014 Capitol Fly-In program. MORE
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Industry News


New Script for Health Care: Choices Expanding Beyond Hospitals
Utica Observer-Dispatch (NY) (06/29/14) Roth, Amy Neff

Patients in upstate New York are increasingly turning to ambulatory surgery centers (ASCs) for treatment. Compared to a hospital, says ophthalmologist Dr. Patrick Costello, the free-standing Griffiss Eye Surgery Center in Rome provides less expensive, faster, and more convenient care. "Everyone is highly specialized," he says. "Typically, I can do two-and-a-half times as many cases at the surgery center in the same amount of time. And I'm not operating any faster." Two more ASCs are being planned in the region: one focusing on orthopedic, plastic, and pain surgery center, and another for pain management. As more services shift away from hospitals into community settings, hospitals are being forced to change, cutting back on inpatient beds and providing more outpatient services. Rome Memorial Hospital is a partner in the Griffiss eye center, for example, in a deal that was structured to make sure the facility did not affect hospital finances or services, according to ophthalmologist Dr. John Costello.
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CMS Developing ICD-10 National Timeline to Help Stakeholders
Health Data Management (06/14) Slabodkin, Greg

In an effort to help stakeholders prepare for the expected new Oct. 1, 2015 ICD-10 implementation deadline, the Centers for Medicare and Medicaid Services (CMS) plans to issue a national timeline. "Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline," said Denesecia Green, acting director of the Administrative Simplification Group at CMS, in a June 26 eHealth Initiative webcast. She added, "We have about 90 partners that we're lining up now to commit to when they are going to test. We're going to make that publicly available for the groups that are willing to do that." CMS discovered that when some clearinghouses and other vendors were prepared to test for ICD-10, some small providers were not. Green said the timeline will "lay out which payers are going to test and when their testing timeframes are, so groups can prepare to test with them as appropriate."
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Surgeries Performed in ASCs Were Often Less Costly Than Hospital Outpatient Surgeries
PR Web (06/24/14)

A new study from the Workers Compensation Research Institute indicates that when ambulatory surgery centers' (ASC) fee schedules were lower than hospital outpatient fee schedules, the payments were also lower. Differences in fee schedule rates were a key factor in Illinois, South Carolina, and Texas. When ASC fee schedules were similar to hospital outpatient fee schedules, the payments were mostly similar. The study also found that payments for ASC surgeries used a fixed-amount fee schedule in Florida, Maryland, Michigan, and Pennsylvania, while payments for hospital outpatient surgeries in these states were linked to charges, leading to significant differences in payments for ASC and for hospital outpatient surgeries. The study analyzed ASC and hospital outpatient facility payments for common knee and shoulder surgeries performed in 23 states in 2011.
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Variation in Ambulatory Surgery Utilization in Michigan
Journal of Surgical Research (06/14) Vol. 189, No. 2, P. 255 Sheetz, Kyle H.; Corona, Lauren; Cramm, Shannon; et al.

In an effort to describe Michigan's ambulatory surgical practices for common surgical procedures, researchers identified more than 33,000 patients via the Michigan Surgery Quality Collaborative clinical registry who underwent general surgical procedures on an ambulatory basis between 25 percent and 75 percent of the time. The researchers used logistic regression models to adjust ambulatory surgery utilization rates based on patients' concurrent illnesses, procedure composition, and hospital characteristics, in addition to assessing the incidence of postoperative complications across hospitals grouped by their ambulatory surgery utilization rates. There was wide variation in ambulatory surgery utilization for general surgical procedures, and the authors could not account for observed differences in patient comorbidities, case mix, or hospital characteristics. "These data suggest that understanding factors associated with ambulatory surgery utilization may represent a novel avenue for quality improvement within our statewide surgical collaborative," the researchers write.
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Frontier Healthcare Holdings Partners With Long Island Digestive Disease Consultants to Open Ambulatory Surgery Center in Port Jefferson Station
Frontier Healthcare (06/19/14)

The Long Island Digestive Endoscopy Center, a partnership between Frontier Healthcare Holdings and Long Island Digestive Disease Consultants, saw its first patients on June 9, 2014. The 10,000-square foot facility, located in Suffolk County, N.Y., is Frontier Healthcare's ninth ambulatory surgery center. The center has three procedure rooms, with five pre-op and 10 recovery beds, and it is expected to see more than 8,000 patient visits in its first year. In addition to surgery, the center plans to hold outreach efforts that provide free or lower-cost colorectal cancer screenings to those without insurance in the community.
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Multifaceted Initiative to Reduce 'Alarm Fatigue' on Cardiac Unit Reduces Alarms and Increases Nurse and Patient Satisfaction
AHRQ Innovations Exchange (06/18/2014) Whalen, Deborah; Piepenbrink, James

In an effort to reduce alarm fatigue, Boston Medical Center has implemented a series of interventions in its cardiac unit. These actions include expanding default parameters that trigger alarms as a result of low and rapid heart rates and incorporating an audible alarm for atrial fibrillation episodes to the existing visual alarm. The facility also elevated heart rate alarms and other rhythm violation alarms deemed "warning" alarms to "crisis" alarms requiring a nurse's response. Additionally, two nurses were allowed to collaborate to change alarm parameters for individual patients, contingent on physician approval. These efforts reduced audible alarms by 89 percent, with no adverse events attributed to the changes as well as increased satisfaction among nurses and patients.
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TransUnion Survey: Providers Fall Short of Meeting Growing Patient Demand for Greater Healthcare Cost Transparency
TransUnion Healthcare (06/23/14)

Approximately two-thirds of Americans are consistently surprised by their medical bills, according to a new survey. The report found that only a quarter of patients receive pre-treatment cost estimates from their providers, while 54 percent said they were either sometimes or always confused by bills and 62 percent were sometimes or always surprised by out-of-pocket expenses. More than 80 percent of the respondents said that receiving pre-treatment cost estimates and insurance coverage estimates would be "helpful" or "extremely helpful" in managing medical costs. "Our survey results shed light on the fact that patients are more attuned to health care costs and billing experiences as they take a more active role in evaluating and selecting their health care options," said Dave Wojczynski, senior vice president of TransUnion Healthcare.
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Pre-Surgery Routines Might Be Doing More Harm Than Good for Patients
PRI's The World (06/22/14) Wernick, Adam

Mayo Clinic researchers are challenging long-accepted standards for surgery, such as fasting before and after an abdominal procedure and taking IV painkillers as part of recovery. Dr. Robert Cima, who chairs the clinic's surgical safety and quality committee, says there is little scientific basis for today's protocols, which he suggests may even be working against patients' well-being. "A lot of the things we've done in the past don't add up to patient benefit," Cima argues. "We should be trying to get the patient back to being who they were beforehand--starting to eat real food, getting up, walking around, avoiding systemic narcotics." This kind of approach, however, demands tightly coordinated patient care among anesthesia providers, nurses, residents, and all other members of a surgical team. A standard of integrated care likely will not abolish the traditional protocols; more likely, Cima says, it will mean learning to balance the old with the new.
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HHS Announces Auto-Enrollment for Current ACA Consumers
Modern Healthcare (06/26/14) Demko, Paul

Under a proposed rule issued by the U.S. Department of Health and Human Services on June 26, individuals enrolled in health plans through the state and federal exchanges will be automatically re-enrolled in coverage for 2015. The rule--up for public comment for 30 days--was drafted in consultation with the National Association of Insurance Commissioners and other entities. The rule aims to avoid disruptions in the marketplace and prevent people from inadvertently losing coverage, says Caroline Pearson, a vice president at Avalere Health.
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Consumers Will Spend More on Health Care in 2015, Report Predicts
New York Times (06/24/14) Carrins, Ann

A report from PricewaterhouseCooper's Health Research Institute projects that growth in health care spending will reach 6.8 percent overall during 2015. The report speculated that growth would partially be driven by consumers who delayed treatment during the economic downturn, who are now able to afford the care that they put off. According to Ceci Connolly, managing director of the institute, after the changes made by employers adjusting their health plan offerings, the net increase in spending is expected to be around 4.8 percent. The report found that the only option offered to employees by some companies is a high-deductible plan, and nearly half of employers say they are considering making high-deductible plans the only option in the next three years in order to encourage employees to consider pricing when they seek care.
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The Joint Commission Alerts Health Care Industry to Prevalence of Unsafe Injection Practices
Joint Commission Sentinel Event Alert (06/16/14) Zhani, Elizabeth Eaken

Thousands of patients who receive injections to treat pain or for other medical purposes end up with infections as a result of improper practices in both inpatient and outpatient settings. The Joint Commission aims to raise awareness of the issue with its Sentinel Event Alert covering the risks of improperly handling vials of injectable medical products. The free publication, "Preventing Infection from the Misuse of Vials," discusses how patients can contract meningitis, hepatitis, and other types of infections when health care workers use a single-dose vial of product multiple times or use the same syringe to re-enter a vial more than once. To produce Sentinel Event Alerts, the Joint Commission draws from its own database of serious adverse events and their underlying causes.
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Evaluation of Hospital Readmissions in Surgical Patients
JAMA Surgery (06/11/2014) Sacks, Greg D.; Dawes, Aaron J.; Russell, Marcia M.; et al.

To measure readmission rates and impose a fine on hospitals with higher-than-expected readmission rates, the Centers for Medicare & Medicaid Services (CMS) developed an all-cause readmission measure that uses administrative data. Researchers wanted to examine the accuracy of administrative codes in identifying cause of readmission as determined by medical record review and the measure's ability to accurately identify a readmission as planned. Researchers conducted a retrospective review of all consecutive patients discharged from general surgery services at a tertiary care, university-affiliated teaching hospital from 2009 to 2011. After assessing both clinical and claims database information, the researchers found that the CMS' Hospital-Wide All-Cause Unplanned Readmission Measure tended to be inaccurate and failed to identify the actual number of planned readmissions. Using risk adjustment to fairly and accurately compare hospitals based on their readmission rates is a potential next step, they said.
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Identifying and Preventing Medical Errors in Patients With Limited English Proficiency: Key Findings and Tools for the Field
Journal for Healthcare Quality (06/01/2014) Vol. 36, No. 3, P. 05 Wasserman, Melanie; Renfrew, Megan R.; R. Green, Alexander; et al.

The approximately 25 million people nationwide with limited English proficiency (LEP) are more likely to experience patient safety events due to miscommunication than English-speaking people. The Agency for Healthcare Research and Quality sought to improve safety for LEP patients through the use to two new tools: a guide for hospitals and TeamSTEPPS. The guide outlines several recommendations such as strengthening interpreter services and improving coordination of clinical services, while TeamSTEPPS features a training module. Both tools were found to facilitate learning, were deployable, and were acceptable to their audiences.
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