ASCA News Digest (July 15, 2014)

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July 15, 2014





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ASCA Highlights


Informed Consent in the ASC: Legal Considerations and Implications

Examine the informed consent process in the ASC setting and the ways that informed consent applies. Learn what your ASC and its staff need to do to protect your facility from litigation during ASCA's next webinar "Informed Consent in the ASC: Legal Considerations and Implications" on Tuesday, July 22, at 1:00 pm ET. 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.



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.



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!

The digital edition of the August issue of ASC Focus is now available. Read the latest issue to learn how to boost your business office, how to avoid perioperative complications with a careful patient assessment plan and compliance tips for small ASCs. MORE
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If you’re an ASC professional seeking advanced educational content and networking opportunities, register today for ASCA’s 2014 Fall Seminar in Scottsdale, Arizona, October 9–11. ASCA members enjoy a discounted registration fee and can save even more by registering before August 31. The 2014 Fall Seminar will also offer the CASC Review Course and Exam. MORE
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Planning has begun for ASCA 2015 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 will provide every year. Submissions for ASCA 2014 will be accepted through July 31, 2014. MORE
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If you haven’t purchased your 2014 subscription yet, there is still time to sign up. The collection period will close July 31. ASCA Benchmarking features some significant improvements for the 2014 program, including an Executive Summary section, new survey questions and enhanced help capabilities. Subscribe today and start submitting your data before July 31. MORE
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ASCA submitted a letter today in response to a recent Novitas proposal that would limit the cases in which the contractor would pay for modified anesthesia care (MAC) services. In the letter, ASCA asks Novitas to reconsider its policy and leave the determination of the medical necessity of a procedure or service to the patient’s physician who has the training, experience and skills necessary to make these decisions. MORE
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Industry News


Is the Hospital of the Future Not a Hospital at All, at Least Not as We Know It?
MSDN HealthBlog (07/07/2014) Crounse, Bill

A new report from Triple Tree examines how changes in reimbursement, alternate care sites, and rising consumer expectations are impacting how and where care is being delivered. The report suggests that, "The hospital of the future may not be a hospital at all," and looks at the practices of outpatient facilities and ambulatory surgery centers. The report provides instances of how some facilities are partnering with hotel chains and home health service companies to provide overnight accommodations and monitoring for patients needing post-surgical or post-procedural care, forecasting likely growth areas to include oncology, urology, otolaryngology, gynecology, and gastroenterology.
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Congress Asks for Details on ICD-10 Delay, CMS Plan for 2015
EHR Intelligence (07/08/2014) Bresnick, Jennifer

Six U.S. lawmakers have sent a letter to Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS), to request more information about the delay in ICD-10 compliance. The letter--signed by Ron Wyden (D-Ore.), Orrin Hatch (R-Utah), Dave Camp (R-Mich.), Sander Levin (D-Mich.), Fred Upton (R-Mich.), and Henry Waxman (D-Calif.)--requests information about what ICD-10 outreach and educational efforts CMS has planned for the 15 months remaining before the implementation date as well as ways for stakeholders to take part in ICD-10 readiness planning. The letter also requests "information on the rationale behind [the] decision" to cancel the end-to-end testing pilot slated for July and a timeline for new testing opportunities.
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Health Insurers Are Trying New Payment Models, Study Shows
New York Times (07/10/14) P. B3 Abelson, Reed

A survey of Blue Cross insurers reveals that health insurers are moving away from reimbursing providers based on the numbers of tests and procedures performed and are experimenting with new reimbursement formulas. About $1 out of every $5 in reimbursements is paid under arrangements in which providers are rewarded for reducing costs and improving care, according to the survey by the Blue Cross Blue Shield Association. The survey indicates that insurers are spending over $65 billion per year in new "value-based" payment models, which include medical homes, accountable care organizations, and flat fees for specific procedures. Although the early results of these experiments are promising, experts say a major change in provider payments will likely take several years.
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Agency Wants Medicare to Cut Outpatient Surgery Payments to Hospitals
Naples Daily News (FL) (07/07/14) Freeman, Liz

Tom Buckley, executive director of Naples Day Surgery in Florida, does not expect immediate changes in the wake of MedPac's recommendation of payment cuts to hospital outpatient surgery programs to more closely reflect what Medicare pays independent surgery centers. "If the government was serious about reducing the deficit and controlling health care costs, they would figure out a way to reduce (the payments) to the outpatient hospital departments," says Buckley. The Lee Memorial Health System in Lee County says if the MedPac recommendation were adopted, it would affect the public hospital system's ability to provide charity care of $48 million as it did last year. "Hospital-based outpatient surgery centers operate under very different operational regulations than freestanding ambulatory surgery centers," says Lee Memorial spokeswoman Mary Briggs. In the early 1980s, Medicare began covering services in independent surgery centers in recognition that some procedures could be done safely. Payments under a formula are about 67 percent of what the rates are for outpatient programs at hospitals. None of this comes as a surprise to the Florida Society of Ambulatory Surgical Centers because of the system used to pay for workers compensation, which hasn’t changed since 2006, says Peter Lohrengel, the group’s executive director. “We get paid 54 percent of what hospitals get paid,” he notes.
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Hospitals, Regulators Spar Over In-Patient Care Policy
USA Today (07/13/14) O'Donnell, Jayne

Consumer and hospital groups are suing the government because they claim a new federal rule that has resulted in fewer patients lingering for days in hospitals without being admitted has compromised Medicare patients' care. The groups also assert the rule has often left patients stuck with costly, unexpected bills. Under the rule, doctors have to certify that a patient has a serious enough condition to need at least two overnight stays for Medicare to cover an inpatient admission. However, patients can remain in an outpatient or "observation" status — that can even include staying overnight for several nights in a typical hospital room — even though they haven't been formally admitted as an inpatient. Outpatient or observational care does not include post-release treatment. Outpatient hospital visits also have higher cost-sharing for individual services, and medications are billed separately by the hospitals' pharmacies. The issue can be especially confusing to patients who don't realize they have different co-payments or other cost-sharing for inpatient and outpatient/observational care. The Centers for Medicare and Medicaid Services says it adopted this "two midnight" rule because auditors found many patients were being admitted unnecessarily. The Senate Special Committee on Aging plans to hold a hearing later this month on the rule because of concerns about the effect on Medicare patients.
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Issuance of Proposed Rule for Medicare Physician Fee Schedule Is Encouraging, But Does Not Address Critical Codes Under Current Review
Value of Colonoscopy (07/07/2014) Sarles, Jr., Harry E.; Allen, John I.; Schmitt, Colleen M.

On July 3, the Centers for Medicare & Medicaid Services (CMS) announced plans to revise the process for setting physician reimbursement in the Medicare Part B program. The leaders of three gastroenterology societies--the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy--note that colonoscopy is one of the major codes under review by CMS that are scheduled for 2015 decision making. They say CMS should either delay revisions or create another avenue for meaningful comment and input on proposed changes to reimbursement. The leaders point out that publishing changes to reimbursement for colonoscopy in the Medicare Physician Fee Schedule Final Rule in November would allow fewer than 60 days for physicians and patients to prepare for these changes. The gastroenterology societies call for three key elements in the Medicare rate-setting process: transparency, stakeholder participation, and accountability.
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Hospital Level Under-Utilization of Minimally Invasive Surgery in the United States: Retrospective Review
BMJ (07/08/14) Cooper, Michol A.; Hutfless, Susan; Segev, Dorry L.; et al.

Minimally invasive surgery is underused, according to new research from Johns Hopkins University, and increasing its use could help to reduce the risk of surgical complications. The study examined U.S. hospital level utilization of minimally invasive surgery for four common surgical procedures: appendectomy, colectomy, total abdominal hysterectomy, and lung lobectomy. Using a nationwide inpatient sample database from 2010, the researchers used a representative sample of 1,051 hospitals in 45 states to examine the actual and predicted proportion of procedures performed with minimally invasive surgery. Minimally invasive surgery is associated with lower complications and improved postoperative recovery, but the choice of operations is often based on surgeon preference. A wide variation in the use of minimally invasive surgery by hospitals in the United States was found after adjusting for differences in a hospital's unique patient population. "Important ways to deal with this disparity may be more standardized postgraduate training, training of surgeons currently in practice, transparency of hospital rates of utilization of minimally invasive surgery, and better information for patients," the researchers concluded.
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2 Charleston Women Receive Free Cataract Surgery From Charleston Based Operation Sight
WCBD.com (SC) (07/08/14) Murray, Carolyn

Two women recently underwent free cataract surgeries at the Physicians Eye Surgery Center in Charleston, S.C. The procedures were performed by Dr. Kerry Solomon, one of 13 volunteer surgeons working through two area surgery centers that are part of Operation Sight-Charleston (OSC), via the ASCRS Foundation's new Operation Sight network. The patients had advanced cataracts, but they did not have private insurance and were ineligible for government assistance. OSC has provided more than 90 free cataract surgeries for South Carolina residents since it was launched three years ago. OSC is a founding member of the Operation Sight network, which hopes to complete 100 surgeries around the nation in the coming year.
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Cash-Only Looks Good to Doctors
Healthcare Finance News (06/30/14) Worth, Tammy

There is anecdotal evidence that the number of physicians' practices that have dropped out of the managed care system and have started accepting only cash is on the rise. A report issued by the Center for Studying Health System Change in 2008 estimated that 12.4 percent of physicians' practices had stopped accepting insurance. A growing number of these practices are run by specialists, says Free Market Health Group President Daniel Goldberg. Goldberg says there are a number of reasons why specialists and other physicians are moving to a cash-only system, including lower reimbursements, problems associated with billing and collections, and a desire to capture business from patients who are inclined to travel abroad for lower-cost surgery.
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Hospital-Based Acute Care After Outpatient Colonoscopy: Implications for Quality Measurement in the Ambulatory Setting
Medical Care (06/30/14) Fox, Justin P.; Burkardt, Deepika D'Cunha; Ranasinghe, Isuru; et al.

Following an outpatient colonoscopy, patients more commonly experience hospital-based acute care encounters than need immediate hospital transfer, according to new research. The study, which used state ambulatory surgery databases from the 2009-2010 Healthcare Cost and Utilization Project, looked at immediate hospital transfer and overall acute health care utilization in the two weeks after colonoscopy for more than 1.1 million colonoscopies performed at 1019 centers. The median risk-standardized hospital transfer rate was 0.0 percent at the ambulatory surgery center level, while the hospital-based acute care rate was 2.1 percent. The researchers suggest that including hospital-based acute care in the postdischarge period as a quality measure could "provide a more complete measure of quality."
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