2014 Final Rule Quality Reporting FAQs

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The new quality reporting measures for the CY 2016 payment determination and subsequent years are:

  • ASC-9: Endoscopy/Polyp Surveillance: Appropriate follow-up interval for normal colonoscopy in average risk patients;

  • ASC-10: Endoscopy/Poly Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use; and

The implementation of a third measure has been delayed until January 1, 2015:

  • ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery

As a reminder, the other 8 measures that were previously finalized by CMS are:

  • ASC-1: Patient Burn

  • ASC-2: Patient Fall

  • ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant

  • ASC-4: Hospital Transfer/Admission

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing*

  • ASC-6: Safe Surgery Checklist Use**

  • ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures**

  • ASC-8: Influenza Vaccination Coverage among Healthcare Personnel***

*New measure for the CY 2014 payment determination.

**New measure for the CY 2015 payment determination.

***New measure for the CY 2016 payment determination.

For the two new measures, ASCs will only be required to collect information on a “sample of eligible patients with minimal case number requirements.” CMS indicates that the Specifications Manual will include the detailed information on the sample, and we anticipate this document will be available by the end of December.

For the two new measures, aggregate data (numerators, denominators, and exclusions) on all ASC patients for these three measures via an online Web-based tool that will be made available to ASCs via the QualityNet Web site. More information will be included in the Specifications Manual which we anticipate will be available by the end of December.

Currently, ASCs must successfully report at least 50 percent of claims meeting measure specifications. The 2014 final payment rule maintains this threshold for this coming year. However, CMS indicates in the final rule it intends to increase the percentage in future years.

New this year, the final rule finalized a minimum case volume requirement for the CY 2016 payment determination and subsequent years. Centers must report quality data if they perform 240 Medicare claims (primary plus secondary payer) per year. ASCs with fewer than 240 Medicare claims per year during a reporting period for a payment determination year would not be required to participate in the ASCQR Program for the subsequent reporting period for that subsequent payment determination year. For example, if an ASC had 200 Medicare claims during the calendar year of January 1, 2013 to December 31, 2013, the ASC would not be required to participate in the ASCQR Program for the 2016 payment determination, meaning they would not need to collect data during 2014. The center should closely monitor how many Medicare cases they perform in 2014, however, because if it meets the 240 threshold the center would be required to begin collecting data again in 2015.

To align these two structural measures with the claims-based measures, CMS has determined that ASCs will not report these two measures in 2014 for data collected in 2013. ASCs will be required to collect on services performed from January 1, 2014 to December 31, 2014 to report in 2015.

The final rule sets an August 15, 2015 deadline for ASCs to submit 2014-2015 influenza vaccination data (October 1, 2014 through March 31, 2015) through the National Healthcare Safety Network (NHSN) which is managed by the Centers for Disease Control and Prevention (CDC). ASCA will continue working closely with the CDC and will educate members on operational aspects of reporting this measure as soon as we receive more information.

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