ambulatory surgery centers

5 CMS Updates for ASCs in 2014

Below are 5 recent legislative and legal updates impacting the ambulatory surgery center industry on the national and state level. 

1. January 1, 2014 marked the beginning of the 2014 Medicare N1 codes. There are 210 new procedures given N1 status by Medicare, most of which were separately paid in previous years. The new regulation applies to the ASC, not the physician, and only for Medicare covered patients. Learn more about the new N1 codes here.

2. The Centers for Medicare and Medicaid Services proposed expanding emergency preparedness requirements at the end of last year. Providers, including ASCs, would be required to: 

  • Develop an emergency plan using an all-hazards approach focusing on capacities and capabilities;
  • Develop and implement policies and procedures based on the risk assessment and emergency plan;
  • Develop and maintain a communication plan complying with federal and state law to coordinate across healthcare providers and with state, local and public health departments and emergency systems;
  • Develop and maintain training and testing programs.

3. The CMS Final Payment Rule includes new quality reporting requirements for cataract surgery. The new requirements include reporting improvement in the patient's visual function within 90 days following cataract surgery, which is a patient reported outcome measure. According to the report, several stakeholders have met with members of Congress to raise issue with the new measure and the potential for unfair penalization under the current rule.

4. In January, MedPAC made the final recommendation for pay rates in 2015, recommending ASCs get no pay raise next year. MedPAC recommended increasing hospital inpatient and outpatient prospective payment systems by 3.25 percent. However, MedPAC also suggested reducing or eliminating the differences between hospital outpatient departments and physician offices for some procedures.

5. It was announced earlier this year that CMS delayed data collection for three new quality measures that were finalized for inclusion in the Ambulatory Surgical Center Quality Reporting Program until April 1. ASCs still need to report data from this year, but instead of reporting for all 12 months only patient encounters from April 1 to Dec. 31 should be included. 

For more information and a complete list of updates please visit Becker's ASC Review.

 

A Retrospective Study of A Gastroenterology Facility: Are the Patients Sicker?

With the ever increasing number of outpatient surgeries coupled with advancement in technology for non-invasive procedures and shorter acting anesthetics, more and more patients are being treated at freestanding surgery facilities. However, the trend in patient co-morbities has also risen, increasing the risk of providing anesthesia even though the procedures are so-called "low-risk". This makes one wonder are the patients being treated in freestanding surgery facilities really sicker than they appear? And therefore is their patient safety at risk?

In this excerpt from her dissertation titled A Retrospective Study of A Gastroenterology Facility:Are The Patients Sicker, Kim Riviello DNP, MBA/HCM, CRNA, President of ASG, will discuss the concerns for patient safety in freestanding surgery facilities, despite the procedures being considered "low-risk".

There has been substantial growth in the number of ambulatory surgery centers across the United States. With the advancement in technology for non-invasive procedures, and shorter acting anesthetics, more patients are being seen in the freestanding surgery facility (FSF). However, the trend in patient co-morbidities, i.e., obesity, diabetes, cardiac, and respiratory diseases has also risen, increasing the anesthetic risk even though low risk procedures are performed. The most common malpractice claims have been associated with diagnostic procedures performed in ambulatory surgery centers under monitored anesthesia care (MAC) with patient co-morbidities as contributing factors. The morbidity and mortality of ambulatory surgery patients has led to an increased concern for patient safety in freestanding facilities. Of particular concern is sedation, specifically in gastroenterology (GI) centers. Yet, the Journal of the American Medical Association (JAMA) recently reported that two-thirds of the anesthesia procedures provided during colonoscopies and endoscopies (EGDs) were on “low-risk patients;” suggesting the lack of need for professionally administered anesthesia in GI facilities and implying that specialist monitored anesthesia would contribute to the increased cost of these procedures (Liu, Waxman, Main, & Mattke, 2012). 

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