ASCA News Digest (January 28, 2014)

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January 28, 2014


ASCA Highlights

Industry News

  • Surveyors love to see ASCs using an EMR. Scott Luba of Outpatient Surgery Center of Hilton Head highlights the many benefits of having AmkaiCharts in this Q&A.
  • "The personal service from AmkaiSolutions is impeccable" - Cheryl Bloode, Memorial Spine & Neuroscience Center. Can you say that about your EMR partner? Ask about the AmkaiSolutions difference!
  • Schedule a demo of AmkaiCharts, the #1 EMR for the ASC, and AmkaiOffice, the most intuitive business software on the market.
  • Learn 6 ways to use your EMR as a powerful marketing tool in a recent Becker's ASC Review column from Joe Macies of AmkaiSolutions.
  • AmkaiSolutions is now a subsidiary of Surgical Information Systems – ASCs will benefit from SIS' robust capabilities in product development and support. Follow SIS on LinkedIn, Twitter and Facebook.

ASCA Highlights

Final Week to Submit Q4 Data for ASCA Benchmarking

ASCA Benchmarking subscribers have through this Friday, January 31, to submit data for the fourth quarter (Q4) of 2013. If you have not purchased a subscription yet, ASCA members can take advantage of a special pro-rated introductory rate. MORE
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ASCA’s 2014 Capitol Fly-In Program will be held June 17–18 and September 9–10. Over two days, you will learn about the issues affecting ASCs and the legislative process, and then spend the day on Capitol Hill lobbying your members of Congress to support important ASC legislation. MORE
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Once a remote possibility, ACOs are now a fast-growing reality. ASCs need to explore the ACO options available and figure out how to overcome hurdles to participation and reap the benefits that the various ACO models provide. MORE
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Bundled payment programs are a growing trend throughout health care, and the market is extending into the ASC market. As ASCs look for ways to increase volume and mitigate the risk of tightening reimbursement, understanding how bundled payment programs work is important for evaluating possibilities of developing a bundled payment program. MORE
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ASCA is working with stakeholder groups to raise awareness in Congress about the problems and challenges associated with the three new measures for the CMS ASC Quality Reporting Program. The goal is to educate members of Congress that the measures are inappropriate to the ASC setting and not indicative of facility-level performance. MORE
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Industry News

Health-Care Reform May Stall Ambulatory Surgeries
Buffalo Business First (01/24/14) Franczyk, Annemarie

As an increasing number of people obtain insurance under the Affordable Care Act (ACA), providers such as ambulatory surgery centers might expect their workloads will increase. However, that might not be the case for some providers as a result of a rise in high-deductible insurance plans sold under the ACA that typically require consumers to pay for the first several thousand dollars of care before coverage takes effect. The industry is waiting to see the full effect of the ACA; but Tom Faith, the new president of the New York State Association of Ambulatory Surgery Centers, notes: "The more health care comes out of pocket, the less business we expect." Faith adds that investment in technology could be challenging this year. As centers are being paid based on outcomes, rather than treatments, investing in the latest technology may be less attractive if it works the same as traditional methods, and promoting lesser technology to consumers could be a challenge as well.
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Obamacare Coverage Enrollment Hits 3 Million - Official
Reuters (01/24/14) Morgan, David

Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said in a Jan. 24 blog post that around 3 million people have enrolled in private health insurance under the federal health law, indicating that the initial goal of enrolling 7 million by the end of open enrollment on March 31 may be reached. As public outreach campaigns pick up steam, Tavenner expects more people to enroll. However, it is uncertain how many new enrollees are young adults.
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Momentum Builds for Medicaid Expansion in States
USA Today (01/23/14) Kennedy, Kelly

A study by the Department of Medical Assistance Services, which oversees the Medicaid program in Virginia, indicates that the state could save $1 billion through 2022 by expanding Medicaid. Newly sworn-in Virginia Gov. Terry McAuliffe says that he would find a way around the state legislature to push for Medicaid expansion, if necessary. Meanwhile, a U.S. Department of Health and Human Services report shows that 6.3 million people have joined Medicaid or the Children's Health Insurance Program (CHIP) since Oct. 1, with slightly more than 1 million people enrolling in Medicaid or CHIP in states that did not expand Medicaid. One major factor driving states to reconsider expansion is the fact that their residents already pay for the expansion through their taxes but do not receive the benefits, says Cornell University professor Sean Nicholson.
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Report Shows Biggest Areas of Confusion Over Medicare
Tampa Bay Times (01/22/14) Nohlgren, Stephen

The Medicare Rights Center has released a study focusing on issues that cause the most confusion among consumers. The study found that denials of benefits accounted for 33 percent of calls to the center's consumer help line in 2012, followed by enrollment into Medicare (23 percent), and out-of-pocket expenses (21 percent). "We are seeing a lot of disconnect between employer-provided information about when to enroll in Medicare and the facts," says Medicare Rights Center President Joe Baker. The report recommends that the federal government publicize appeal data for traditional Medicare plans, Medicare Advantage plans, and prescription drug plans. Doing so would make it easier for consumers to select plans, "especially if there are lots of appeals in certain types of services," Baker notes.
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New 39.6 Percent Tax Bracket for Wealthiest People
Associated Press (01/22/14)

More affluent Americans could see higher tax bills this year due to tax legislation passed in early 2013 that added a top marginal tax rate of 39.6 percent for those at higher incomes: $400,000 for single filers, $450,000 for married couples filing jointly, and $425,000 for heads of household. Additionally, some higher-income taxpayers may need to pay capital gains taxes as high as 20 percent. A 0.9 percent Medicare tax is also triggered on earnings higher than $250,000 for married couples filing jointly and $200,000 for singles and heads of household, as is the case for a 3.8 percent tax on investment income. The phaseout of personal exemptions and deductions kicks in at $300,000 for married couples filing jointly and $250,000 for singles.
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'Alarm Fatigue' a Top-of-Mind Concern for U.S. Hospitals, Finds National Survey Presented at Society for Technology in Anesthesia Annual Meeting
Physician-Patient Alliance for Health & Safety (01/22/2014) Wong, Michael

Nineteen out of 20 hospitals say that "alarm fatigue" is a leading concern for them, according to a new survey presented at the Society for Technology in Anesthesia Annual Meeting in Orlando. "Hospitals are greatly concerned about alarm fatigue because it interferes with patient safety, and it exposes patients--and the hospitals themselves--to grave harm," said Michael Wong, executive director of the Physician-Patient Alliance for Health & Safety, who presented alarm fatigue results from the First National Survey of Patient-Controlled Analgesia Practices. To improve alarm management, hospitals should develop a systemic approach that takes into account staffing patterns, care models, architectural layouts, patient populations, and how responsibilities are assigned, said Wong. He noted that 87.8 percent of hospitals surveyed believe that reducing false alarms would increase their use of patient monitoring devices that use capnography and/or pulse oximetry. The survey also found that hospitals that use smart pumps with integrated end tidal monitoring were nearly threefold more likely to see reductions in adverse events or a return on investment in terms of reduced costs and expenses.
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Consumers Expecting Free 'Preventive' Care Sometimes Surprised by Charges
Kaiser Health News (01/21/14) Andrews, Michelle

The Affordable Care Act requires that most health plans cover a wide range of preventive services without charging patients anything out of pocket. However, some patients are encountering coverage exceptions and extra costs when they attempt to obtain those services. Policy experts say more federal guidance is needed to clarify the rules. Meanwhile, the health law allows plans to apply medical management techniques to "control costs and promote efficient delivery of care," so a plan may charge a co-pay for a brand-name contraceptive if a generic version of the same drug is available at no charge, for instance.
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Survey: Drug Shortages Affect Patient Care, Add to Costs
Pharmacy Times (01/20/14) Simone, Aimee

A recent survey of 193 MedAssets members suggests that drug shortages can lead to medication errors, adverse events, patient complaints, and higher institutional costs. The most common errors reported were omission, dispensing, or administering the wrong dose. Analgesics, anesthetics, antiemetics, and electrolytes/total parenteral nutrition were among the drugs most frequently reported to be in short supply. A total of 134 respondents reported a delayed care event related to drug shortages, with 56.5 percent saying one to five delays occurred. Sixty respondents said care had been cancelled as a result of drug shortages, with 88.3 percent citing one to 10 cases of cancelled procedures, surgeries, chemotherapy, and other treatments. Nearly four in 10 respondents said they had received at least one patient complaint related to drug shortages.
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Improving the Timeliness of Procedures in a Pediatric Endoscopy Suite
Pediatrics (01/14) Tomer, Gitit; Choi, Steven; Montalvo, Andrea; et al.

Pediatric endoscopy timeliness and delays can be improved using quality improvement methods and tools, new research shows. Researchers at Children's Hospital at Montefiore, Albert Einstein College of Medicine, in New York, examined ways to enhance the timeliness of pediatric endoscopy procedures via a quality improvement initiative developed in 2010 and implemented through December 2012. The researchers significantly decreased the first case endoscopy delay, from an average of 17 minutes to 10 minutes, as well as subsequent case delays. As a first step, they focused on the department of pediatric gastroenterology and patient-related causes of delays. Interventions used include education of pediatric gastroenterology faculty staff, email communications to faculty, sharing of individual physician performance data, and monthly faculty meetings. Interventions for patent-centered causes of delays include sending letters to caregivers of patents outlining the procedure and how to prepare for the procedure as well as telephone reminders by nurses 12 hours to 24 hours prior to the procedure and a call one week before the procedure by a scheduler.
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Patients' Costs Skyrocket; Specialists' Incomes Soar
New York Times (01/19/14) P. A1 Rosenthal, Elisabeth

Some medical problems may appear minor, but they can still lead to large bills because they involve multiple doctors from different specialties. Bills can also vary based on the location of the procedure, such as a hospital. At the same time, many specialists are focusing on performing the most lucrative procedures, enabling the incomes of dermatologists, gastroenterologists, and oncologists to increase by 50 percent or more between 1995 and 2012, even when adjusted for inflation. These figures may not include revenue from such things as fees for blood or pathology tests at a lab that the doctor owns, for example, or facility charges at an ambulatory surgery center where the physician is an investor. "The high earning in many fields relates mostly to how well they've managed to monetize treatment--if you freeze off 18 lesions and bill separately for surgery for each, it can be very lucrative," said Dr. Steven Schroeder, a professor at the University of California and the chairman of the National Commission on Physician Payment Reform, an initiative funded in part by the Robert Wood Johnson Foundation.
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Rise of Machines in Surgery Lowers Costs, Improves Patient Outcomes
Huffington Post (01/16/14) Wilson, Timothy G.

Robotic-assisted surgery can be a major way to reduce health care costs, enabling more patients to undergo less invasive procedures. With the da Vinci system, notes Dr. Timothy G. Wilson of the City of Hope Cancer Center, there are instruments that maneuver similar to a human wrist in very small spaces, providing increased dexterity. Already, more than 1.5 million da Vinci surgeries have been performed worldwide. Thousands of peer-reviewed clinical studies have assessed the use of robotic-assisted surgery, deeming it safe and effective while helping reduce both the costs and complications of open surgery.
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The Boomer Challenge
Hospitals & Health Networks (01/14) Barr, Paul

The aging of Baby Boomers will likely increase patient volumes at hospitals and expand skills gaps in healthcare. The generational change will require hospitals to adapt quickly, especially given research published in JAMA Internal Medicine indicating that boomers will live longer but have higher rates of hypertension, high cholesterol, diabetes, and obesity than their parents' generation. Greater care coordination will be key as more patients rely on Medicare and struggle with multiple chronic conditions. In addition to retiring providers increasing staff gaps, experts say there already is a dearth of providers with the skills to care for aging patients. Some hospitals are trying to fill the gap by requiring nurses and technicians to complete basic geriatric training. Moreover, new providers are looking for more balance between their work and personal lives. American College of Healthcare Executives CEO Deborah Bowen says the effect of boomer retirements on management ranks is unclear, but hospitals need to ensure succession planning is a priority. Other options to address care gaps include innovative facility design that incorporates elderly care units and mobile health.
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Prior Health Coverage Indicator of Better Health for Medicare
Bloomberg BNA (01/14/14) Teske, Steve

A new report from the Government Accountability Office indicates that health care costs were lower for seniors during their first year on Medicare if they had health insurance for at least six consecutive years prior to enrolling in Medicare. "Specifically, during the first year in Medicare, beneficiaries with prior continuous insurance had approximately $2,300, or 35 percent, less in average predicted total spending than those without prior continuous insurance," says the report. Prior continuous insurance also boosted the probability that beneficiaries reported being in good health by almost six percentage points during the first six years in Medicare. The report indicates that more than 18 percent of the pre-Medicare population, or 7 million people between the ages of 55 and 64, were uninsured during the first half of 2012.
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