Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in providing safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.
Kara Newbury: 0:27
Hello, and welcome to the Advancing Surgical Care Podcast. My name is Kara Newbury, I serve as regulatory counsel and director of government affairs for the Ambulatory Surgery Center Association, and I’m going to be the host of the podcast today. I’m joined by my colleagues David Opong-Wadee, ASCA manager of legislative and political affairs, and Maia Kunkel, ASCA manager of government affairs. I’ve asked David and Maia to join me to discuss ASCA’s federal legislation, the Outpatient Surgery Quality and Access Act, that was introduced earlier this year in both the House and the Senate. If anyone listening is interested in more details than what we have time to cover today, a complete summary is available on the ASCA website. We also want to discuss ASCA’s Washington fly-in, or lobby day, that was held on February 28 and March 1, where we were joined by 70 ASCA members from 31 different states who were able to speak directly with their members of Congress and staff about our legislative goals. So, with that introduction, let me welcome Maia and David to the podcast. Maia, welcome.
Maia Kunkel: 1:34
Great. Thank you, Kara, for having me on.
Kara Newbury: 1:37
Yes, and David.
David Opong-Wadee: 1:38
Yes. Thanks, Kara. So happy to join.
Kara Newbury: 1:41
David, let me start with you. Our federal legislation would benefit both ASCs and the patients they serve. Could you talk just a little bit about the provisions that are of particular benefit and interest to ASC patients and their families?
David Opong-Wadee: 1:55
Absolutely, Kara. There are two provisions that will be particularly beneficial to patients. The first relates to a patient’s ability to access quality data, and the second would eliminate the Medicare copay penalty, as we call it, for Part B services performed in ASCs. I’ll explain the quality data part first. The bill would direct the Department of Health & Human Services to publish a comparison of quality measures for both ASCs and hospital outpatient departments, or HOPDs. There is currently no way for a prospective patient to compare the quality reports for their local ASC with their local HOPD on an apples-to-apples basis. It’s not easy to access this information and the information that is available for ASCs is different than the information that’s available for hospitals. We think this information needs to be more user-friendly and both hospitals and ASCs should report the same quality measures so that patients can make a fair comparison between the two before choosing their site of care. Patients would also be the direct beneficiaries of the Medicare copay issue that we’re trying to fix. Today, if a Medicare patient receives Part B care in an HOPD, their copay is capped. But if they receive the same care in an ASC, there is no cap. We think that’s unfair to the patient and unfair to the ASC, and it actually winds up costing Medicare tons more because there’s an incentive to have the patient go to the HOPD, which is a much more costly site of care for the Medicare program.
Kara Newbury: 3:31
You’re absolutely right, David. And for 2023, just for our listeners’ information, the copay cap is set at $1,600 in the hospital outpatient department setting. So, for any procedure which your Medicare beneficiaries would pay more than, say, $8,000, $9,000, $10,000 dollars, they’re going to be paying a higher copay to have the procedure done in the ASC, which, as we all know, is counterintuitive. So, thanks, David. Maia and David, we’re going to just take a quick break to hear a message from our podcast sponsor. Please stand by and we’ll resume our conversation in just a moment.
This episode of the Advancing Surgical Care Podcast is brought to you by AMSURG, a national leader in the strategic and operational management of ambulatory surgery centers. AMSURG partners with more than 2,000 physicians and health systems and more than 250 ASCs operating in 34 states. Learn more by visiting amsurg.com.
Kara Newbury: 4:33
Okay, Maia, could you please take a quick moment and talk about a couple of the provisions of the bill that you think would be of particular interest to ASCA members?
Maia Kunkel: 4:41
Sure. The parts of the bill that I think would be of most interest to ASCA members are the sections dealing with our annual update factor and reforming the process for adding additional codes to the ASC Covered Procedures List, or the ASC-CPL. Kara, it wasn’t long ago, in fact just as recently as 2018, that the Centers for Medicare & Medicaid Services, or CMS, used the Consumer Price Index, or CPI, as the basis for updating reimbursement levels for ASCs. Historically, that didn’t make any sense since the costs in the CPI, things like fuel and groceries, do not directly impact the cost of operating an ASC. In comparison, hospitals have always been updated using a hospital market basket of health-related costs. This bill would permanently align our update with the hospital update factor. So, the other provision that I think is of importance to the entire ASC community is the section that would require CMS to publish its rationale when it declines to add codes to the ASC-CPL. Kara, I’m sure you know better than anyone, ASCA makes a huge effort every year to provide CMS with data and experts who can attest to safely adding codes to our covered procedures list. Yet, if they decline to approve our request, they almost never provide a reason why, making it impossible to know what we need to do to overcome their objections. So, we think this is a practical, commonsense proposal that ought to be corrected.
Kara Newbury: 6:10
Thanks, Maia. Yes, and we’re actually dealing with this right now because in the 2023 final rule, CMS took at least some effort to provide a rationale. But they lumped all of the procedures that were requested into just a few specialty groups, making it extremely difficult to tell what their specific objections were to each procedure that we’ve requested. So, I think it’s critically important that we keep that provision in the legislation, even though we are going to have, hopefully, this new nomination process from CMS where there will be a portal through which interested parties can submit codes for consideration. But you never know if that’s going to change from year to year, so this provision, I think, is necessary to ensure that we have CMS show their work, basically. So, Maia and David, let’s just take some time now to talk about National Advocacy Day and the fly-in. Of course, it was the first fly-in event that we were able to host in more than three years. The last one was fall of 2019, prior to this one, due to the pandemic, and the response from our members was really inspiring. I thought that the event was a huge success. As we mentioned at the beginning of this podcast, we had 70 members fly in from 31 states. David, can you talk about the congressional office visits and the contacts that were made to help advance our legislation?
David Opong-Wadee: 7:40
Yes, Kara. I think there was a great amount of excitement in terms of this return to in-person meetings and the opportunity for ASCA members to ascend on the hill. We had 102 meetings with congressional staff and members of Congress, and in total, we met with 58 House offices and 44 Senate offices. So, our presence was certainly felt. And I do know that that particular touch from a constituent always resonates far much more than just having a policy discussion. So, we really do encourage members to consider joining us and we’d love to have even more people join us next year. With Democrat and Republican sponsors in both the House and the Senate, we had this great bipartisan story to tell about in terms of building our legislation. Both members and staff were eager to learn that ours was not a partisan proposal but really one that puts patients first, particularly with that copay cap issue that I raised, regardless of whether they are in a red or blue state. Without a doubt, ASCA’s presence was truly felt all across the Capitol—it was not only a chance for us to talk about our legislative proposals, but also a better opportunity to inform congressional staff about the great healthcare that we provide in their districts every day and to better inform them about the growth of healthcare in the ASC setting overall.
Kara Newbury: 9:02
Great. Thanks, David. And I do just want to take a minute while I have you here on the podcast to thank you for all of your hard work helping to coordinate the event and really engaging with our members and the members of Congress and our external lobbyists. So, I really appreciate your help in making this event a success. Maia, what can you share about your couple of days in Washington with the fly-in?
Maia Kunkel: 9:28
Yes, and I really want to reiterate, Kara, the thanks to David and to yourself and the rest of the ASCA team for making this a success for our first fly-in in the past few years, in helping to schedule all of our meetings and making sure that our attendees were able to meet with their local representatives and senators. Overall, we had really great feedback from our members that their meetings not only went super well, but they thought the days were planned out super well also and that allowed them to be extremely productive over the short period of time that they were in Washington, DC. I also heard from attendees that both the members and the staff that they met with were attentive to what we had to say and were supportive of the proposals that they talked about, specifically about the bill. And members of Congress and their staff are obviously very busy people, but they all gave our attendees considerable time and attention. There really is no substitute for a senator or a member of Congress or their staff hearing directly from a constituent, and I encourage everyone listening to the podcast today to consider participating in a future National Advocacy Day—it’s a great personal experience and is extremely beneficial to our legislative efforts.
Kara Newbury: 10:38
Thank you, Maia. And Maia, huge kudos to you—you really kind of took the lead on this event, you took it and ran with it, you did a phenomenal job. I was particularly impressed with the app that we had. So, carrying around our phones, I got to see where our meetings were, who all we were meeting with. So, kudos to you and Jason Hawkins on our staff for that wonderful addition to the fly-in this year. As we’ve talked about internally, unfortunately, now that means that you’re going to have to continue doing that in the future, but I think that it was really well-received by participants. As a reminder to all of our listeners, all ASCA members are invited and encouraged to participate in National Advocacy Day. David, myself, Bill, others on staff, as well as our outside consultants—we get to lobby Congress and the administration throughout the year. But it’s really critical that we have members who are in the facilities on a daily basis who can tell their elected officials what’s going on in the healthcare community on the ground. So, Maia and David, do you have any final words of wisdom for our listeners?
David Opong-Wadee: 11:50
If I can add one more thing—this return to National Advocacy Day also included a reception that we had in the Rayburn building. We would love to see this happen in perpetuity and we know that it could be done quite easily if members contributed to the Advocacy Fund. There’s no partisan or political backing behind the Advocacy Fund, it’s merely a space where you can contribute to our ability to kind of give people more options to see ASCA in the community, on the hill at large, in various settings. And so, we’d love to have people contribute to the Advocacy Fund so we can grow our party. And that’s just another reason for people to want to come to DC—after we work hard for a day, we get to party into the evening.
Kara Newbury: 12:41
Sounds good, David, thanks. Any final words, Maia?
Maia Kunkel: 12:44
Yes, I think the final thing I will say is that every advocacy effort from sending a letter in support of our bill to your members of Congress to flying into DC maybe from across the country to meet in person with your federal lawmakers can have an impact. It can really be a catalyst for positive change for the surgery center community. So, any involvement is usually a positive one and can create lasting change for our community.
Kara Newbury: 13:08
That’s a great point, Maya. And for those on the call who don’t know, Maia does spearhead our grassroots efforts for ASCA. So, if you would like to do a facility tour with elected officials, whether in person or a virtual tour, please don’t hesitate to reach out to Maia. This will conclude our podcast discussion today. I want to remind everyone listening that you can find more information about ASCA’s legislative proposals on the ASCA website or by contacting either David, Maia or myself. And finally, before closing, I would once again like to thank our podcast sponsor AMSURG, a leading ASC management company with more than 250 ASC partners in 34 states. To learn more visit amsurg.com. Thank you for listening and we hope to see you at our 2024 Washington fly-in and National Advocacy Day.