ASCA News Digest (August 12, 2014)

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August 12, 2014


ASCA Highlights

Industry News


ASCA Highlights

Download Sample Comment Letters to Submit to CMS

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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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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ASCA's 2014 Fall Seminar, October 9–11, in Scottsdale, AZ, will offer educational sessions on key topics that drive development and daily operations at your ASC, lively networking opportunities, continuing education contact hours and the Certified Administrator Surgery Center (CASC) Review Course and Exam. 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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CMS' recently-instituted quality reporting program for ASCs poses new challenges for perioperative leaders in the ASC setting. Learn what quality reporting is required and get key definitions and answers to frequently asked questions about the measures your ASC needs to report during ASCA's next webinar on August 19. The webinar will be offered free of charge and a quality reporting program update will be provided. MORE
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Whether you are in a large, multi-specialty ASC or a small, single-specialty ASC, the regulatory and accreditation requirements are the same. When it comes to compliance, however, small ASCs face certain unique challenges. Through planning, preparation and a little organization, small ASCs can minimize what seem to be overwhelming compliance and regulatory difficulties. MORE
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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 or call 800-459-5616 today!

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.

The availability of critical lifesaving medications has become a serious concern across the health care system. ASCA is conducting a brief survey to collect information that will help guide ASCA and government agencies, such as the FDA, as they respond to these critical shortages. If your center has experienced a shortage within the past year, please take a couple of minutes and fill out the survey. You will need to fill out one survey for each drug. MORE
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More than 20 centers are hosting elected officials and other stakeholders tomorrow as part of National ASC Day. Tours offer a close-up view to legislators and regulators of the surgical experience in an ASC, which many of these individuals never get a chance to see. If you are hosting a tour or other event tomorrow as part of National ASC Day, please contact Jack Coleman at 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.

ASCA staff has been receiving inquiries from our membership regarding whether or not facilities are required to sign memorandums of understanding with quality improvement organizations (QIOs). ASCA reached out to CMS staff regarding this question and according to our contact, “ASCs are not required to participate in quality improvement activities with QIOs." MORE
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Industry News

Ambulatory Surgical Centers and Medicare
American Action Forum (08/05/2014) La Couture, Brittany

Under Medicare's Inpatient Only List, roughly 1,700 procedures must be performed solely in an inpatient setting in order to receive Medicare reimbursement, even though many of these procedures are routinely and safely performed in ambulatory surgical centers (ASCs). CMS' decision to exclude ASC use means Medicare patients receive treatment that is more costly and potentially less specialized in some cases. Medicare also uses different measures for hospitals and ASCs when calculating the rate of inflation. This results in hospitals receiving annual inflation increases 300 percent higher than ASCs, while "secondary rescaling" reduces ASC payments when volume increases, resulting in a 67 percent lower reimbursement rate. The overall impact of such policies is that ASCs receive on average 56 percent of what hospitals would receive for the same procedure. CMS ideally should implement a pilot program expanding coverage for ASCs to a wider range of procedures to generate statistically significant data supporting ASC safety.
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New Website Allows Coloradans to Shop and Compare Medical Costs
Rocky Mountain PBS I-News (08/06/2014) Trotter, Jim

Colorado's Center for Improving Value in Health Care (CIVHC) unveiled on July 31 a Web site to allow residents to shop and compare the costs for various medical procedures. The CO Medical Price Compare Web site currently provides price differences for four procedures at different hospitals, and by the end of the year, prices for nine more services at hospitals and ambulatory surgery centers will be available. More than 25 additional other services across multiple facility types are expected to be online in 2015. "Consumers can go in and shop and compare," says CIVHC economist Jonathan Mathieu. "Basically, you check your procedure, type in your zip code, and hit go, and out comes the price information."
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Feds Stop Public Disclosure of Many Serious Hospital Errors
USA Today (08/06/14) O'Donnell, Jayne

The federal government has halted public disclosure of eight serious and avoidable medical errors attributable to hospitals. As of this month, the Centers for Medicare and Medicaid Services (CMS) has publicly removed data on air embolisms, foreign objects left in patients' bodies after surgery, and other hospital-acquired conditions (HACs), leaving researchers with little option but to estimate their own rates using claims data. CMS' Aaron Albright says the changes were implemented to make data "more comprehensive and most relevant to consumers," and were strongly endorsed by the National Quality Forum (NQF). NQF's Ann Grenier says the decision to remove the HAC data was based on the viewpoint that comparing one hospital to another was inappropriate and caused confusion for people who are not full-time hospital employees. CMS notes it is developing new ways of measuring HACs that would account for some of the most common adverse hospital events, and the now publicly unavailable HACs are deemed to be rare events that should never occur.
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Outpatient Total Hip Replacement? Tigard Center Is on the Cutting Edge
Portland Business Journal (OR) (08/04/14) Thompson, Dennis

The Oregon Outpatient Surgery Center in Tigard, Ore., now performs total hip replacement surgery on an outpatient basis. Orthopedic surgeon Dr. James Ballard says outpatient hip replacement is possible due to advances in pain management and the ability to perform the surgery with smaller incisions and less intrusions into the body. He notes that comparatively healthy patients should be eligible for same-day hip replacement, along with people whose diabetes or high blood pressure is well-controlled. Surgery candidates must also be willing to undergo strength training prior to surgery and ensure they can return home to a reliable support system, Ballard says.
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Hospitals Likely to Outsource ICD-10 at Launch
Health Leaders Media (07/31/2014) Commins, John

A study by Black Book Rankings reveals that nearly 50 percent of hospitals surveyed anticipate outsourcing coding work for ICD-10 services, which must go online in October 2015. The study also noted that transcription services are currently outsourced by 63 percent of hospitals, which is expected to increase to more than 70 percent of providers as the ICD-10 deadline approaches. Melanie Endicott at the American Health Information Management Association says providers are aware that productivity is likely to decline in October 2015 as coding staff adjust to the new system. She estimates that some facilities may require additional help until their own coders are up to speed, or they may hire outsourced coders to reduce a backlog.
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National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease
Global Spine Journal (08/01/2014) Vol. 04, No. 3, P. 143 Baird, Evan O.; Egorova, Natalia N.; McAnany, Steven J.; et al.

An increasing number of cervical spine surgeries are being performed in an ambulatory setting, according to new research. The retrospective study, from researchers at The Mount Sinai Hospital in New York, used the U.S. Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. ICD-9-CM and CPT-4 codes were used to identify operations for degenerative cervical spine diseases in adults above age 20. Anterior cervical diskectomy and fusion made up 68 percent of the outpatient cervical spine procedures, while posterior decompression accounted for 21 percent. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The authors note that while more than 99 percent of patients are discharged home, "this increase in outpatient cervical spine surgery necessitates further discussion of its safety."
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Fewer Uninsured Face Fines as Health Law's Exemptions Swell
Wall Street Journal (08/07/14) P. A1 Armour, Stephanie

According to an analysis by the Congressional Budget Office and the Joint Committee on Taxation, nearly 90 percent of the nation's 30 million uninsured will not pay a penalty in 2016 because they qualify for one or more exemptions under the Affordable Care Act. There are 14 ways to avoid the fine under the individual mandate based on hardships, such as domestic violence, substantial property damage from a fire or flood, or having a canceled insurance plan or an electricity shut-off notice, and residents in states that opted not to expand Medicaid also may be exempt. Under the new exemptions, the government now expects 4 million people to pay the fine in 2016, down from a previous projection of 6 million. Insurers are worried about these exemptions, as they could make it easier for younger, healthier people to avoid obtaining coverage, leading to increases in premiums because old people or those with health problems would make up most of the pool of the insured.
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Hospital Offers Patient Updates at Your Fingertips
Connecticut Post (CT) (08/02/14) Cuda, Amanda

A new texting program for relatives of patients undergoing ambulatory surgery at Greenwich Hospital is being used to promptly report updates on a patient's treatment. Texts are issued in English or Spanish to predesignated family members at the start of surgery, the arrival of the patient in recovery, and the point when a patient is ready to be discharged. The service is offered through FamilyTouch's free messaging program. Already, the system has been used by more than 200 patients, and more than 3,100 text messages have been sent, which helps alleviate family members' stress, says Christine Beechner, the Connecticut hospital's vice president of patient and guest relations.
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Medstar Health Gets Approval for 'One-Stop' Health Shop South of Dupont Circle
Washington Business Journal (07/31/14) Reed, Tina

Regulators in Washington, D.C., have approved MedStar Health's request to build an ambulatory care center in the city. Work is expected to begin on the $26 million facility in Lafayette Center in early 2015, officials say, with an expected opening date of June 2016. MedStar's application was approved as part of the District's Certificate of Need process. MedStar will occupy 97,500 square feet of leased space for outpatient rehabilitation, diagnostic imaging, and ambulatory, primary, and specialty care. The company said it will relocate to the new site an ambulatory surgery unit, two primary care practices, a cardiology specialist, a men's and women's health clinic, and a bone, sport and joint center.
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Hospital Facility Fees: Why Cost May Give Independent Physicians an Edge
Medical Economics (08/06/14) Worth, Tammy

Hospitals and large health systems typically cost more than independent practices, even for the same procedures. A key reason is facility fees. The Medicare Payment Advisory Commission recommends that Medicare equalize fees between hospitals, private practices, and other settings, such as ambulatory surgical centers, for services that can be provided safely in the lower cost setting. Some independent physicians are opting to join accountable care organizations or independent physician associations to ensure they can provide high-quality services while also curbing costs.
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HHS Report Finds Medicare Advantage Plans Exaggerate Members' Diseases to Make More Money
Kaiser Health News (08/07/14) Schulte, Fred

U.S. Department of Health and Human Services researchers found that many Medicare Advantage plans have long over-billed the government for treating elderly patients, exaggerating how sick patients are and how much their treatment costs. The study by HHS Agency for Healthcare Research and Quality Director Richard Kronick and W. Peter Welch of the HHS Office of the Assistant Secretary for Planning and Evaluation determined that people who enroll in Medicare Advantage plans generally are healthier than those on standard Medicare, but there was a faster growth rate in the number of Medicare Advantage patients diagnosed with diseases resulting in higher payments than among standard Medicare beneficiaries. Drug and alcohol dependence, for instance, was eight times more common in the highest coding Medicare Advantage plans, and diabetes with serious complications was reported up to five times more often. Although the study does not name the plans that were analyzed or accuse specific insurers of wrongdoing, it does indicate that "further policy changes will likely be necessary."
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