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The second data submission deadline for ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel is Tuesday, November 15, and covers the data collected in the second quarter of 2022, April 1 through June 30. For ASC-20, facilities must select one week per month on which to report to meet the quarterly submission requirement. The Ambulatory Surgical Center Quality Reporting (ASCQR) Program provides a Web-Based Measure Status Listing that allows facilities to check their data submission status for web-based measures in the program. Enter your ASC’s NPI or CCN in the ASC Facility and CCN Lookup section to see your facility’s submission status. Please note that currently this page is only being updated monthly, so if you just submitted your data, it might not yet be displayed there. The deadline to request an exception for failing to report first quarter 2022 data is rapidly approaching as well. If your facility was unable to submit required information by the first reporting deadline (August 15) due to an extraordinary circumstance, your ASC may request an exception. To request an exception, you must submit a completed Extraordinary Circumstances Exceptions form with any required information and supporting documentation within 90 calendar days of the missed deadline. These documents must be submitted to the ASC Support Contractor via one of the following:
• the Hospital Quality Reporting Secure Portal, Managed File Transfer (MFT) to QRFormsSubmission@hsag.com (opens in new browser tab). Note: When sending via MFT, uncheck “Require Registered Users.”
• email directly to: QRFormsSubmission@hsag.com
• secure fax to: 877.789.4443
The results are mixed for surgery centers
CMS finalized an effective update of 3.8 percent—a combination of a 4.1 percent inflation update based on the hospital market basket and a productivity reduction of 0.3 percentage points mandated by the Affordable Care Act. This is an increase of 1.1 percent from the proposed rule. Please note that this is an average and updates might vary significantly by code and specialty.
This update is based on CMS’ 2019 policy to align the ASC update factor with the one used to update HOPD payments, the hospital market basket, for a five-year trial period as the agency assesses this policy’s impact on volume migration. As 2023 is slated to be the last year of the trial, CMS indicates in this final rule that the agency intends to “update the public on our assessment of service migration and other factors in the CY 2024 OPPS/ASC proposed rule.”
We are relieved that CMS has increased the inflation update from what was proposed initially, but it still falls far short of addressing the escalating costs that surgery centers are experiencing in staffing, services and supplies,” says ASCA Chief Executive Officer Bill Prentice. “CMS needs to do more to support ASCs in confronting the rising costs of providing care to beneficiaries or risk losing access to the outstanding care and significant cost savings ASCs provide.”
Other initial observations about the 1764-page final rule follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally under this final rule.
ASC Complexity Adjustments
On a positive note, CMS finalized a policy to provide complexity adjustments for combinations of certain service codes and add-on procedure codes that are eligible for a complexity adjustment under the hospital outpatient prospective payment system (OPPS). While add-on codes (N1) do not receive additional reimbursement when packaged into primary codes, the addition of the add-on codes to a primary procedure code often changes the complexity of the procedure, making it more costly to perform. As finalized in this rule, Medicare will now provide a “complexity adjustment” to adjust the payment rate for certain primary procedures to account for the cost of also performing certain add-on procedures.
“We support CMS in adopting complexity adjustments that will enable surgery centers to provide better access to beneficiaries and protect Medicare’s sustainability for years to come,” Prentice says.
The complexity adjustments adoption is a significant change for ASCs. ASCA will provide more educational materials on its implementation in the near future.
Additions to the ASC Covered Procedures List
Although ASCA provided a list of dozens of procedures that are performed safely on non-Medicare populations in the ASC setting for consideration to be added to the ASC Covered Procedures List (ASC-CPL), CMS added only four of the requested codes:
• 19307 (Mast mod rad)
• 37193 (Rem endovas vena cava filter)
• 38531 (Open bx/exc inguinofem nodes)
• 43774 (Lap rmvl gastr adj all parts).
“CMS’s decision to add only four new procedures to the ASC-CPL for 2023 after ASCA proposed 47 procedures that ASCs are performing safely and successfully for privately insured patients is a serious mistake and denies beneficiary access to high-value care,” Prentice says. “Forcing otherwise healthy Medicare beneficiaries to receive care in higher cost settings for these procedures needlessly increases costs to the Medicare program and undercuts Medicare’s mission of serving as a responsible steward of public funds.”
Positive Change to ASC Quality Reporting Program
CMS finalized its proposal to suspend the mandatory adoption of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery in the ASC Quality Reporting Program. ASCA has been strongly advocating for this measure to remain voluntary.
ASCA will continue to analyze the rule in detail and provide more information to help ASC operators understand the impact of the proposal on their centers soon.
ASCA – No Surprise Billing Act
No Surprises Act: Recapping the First Year and Preparing for the Future
Tuesday, November 15, 2022, at 1:00 pm ET
Free webinar to all ASCA members, or $50 for nonmembers. For more information and registration click here.
If a patient is in good health with no chronic conditions and has never had an adverse reaction to anesthesia, consider choosing an ambulatory surgical center for routine outpatient procedures instead of the hospital. Outpatient procedures that are increasingly done in ASCs include the following:
How does this help you?
Choosing an ASC can give health care providers more control over surgical practices, more flexible scheduling and lower facility fees. Additionally, the list of covered surgical procedures at ASCs is growing each year. According to Becker’s ASC Review,** six coronary intervention procedures, including cardiac stenting, may be added to that list in 2020, as proposed by the Centers for Medicare & Medicaid Services.
What’s in it for patients?
With ASCs, patients benefit from more convenient locations, shorter wait times for scheduling procedures, a lower chance of post-operative infections and lower cost share than outpatient surgery in a hospital. All these factors contribute to higher overall patient satisfaction. Procedures typically take less time than those done at hospital outpatient departments, so patients are under anesthesia for a shorter period of time, leading to less complications.***
The decision to choose an ASC versus a hospital outpatient department for a patient lies with the provider, but if using an ASC is appropriate for the patient, choosing an ASC could be a win-win situation.
**Content provided by Becker’s Hospital Review. Blue Cross Blue Shield of Michigan doesn’t own or control this content.
***Content provided by Health Leaders Media. Blue Cross Blue Shield of Michigan doesn’t own or control this content.
What are Ambulatory Surgery Centers?
Michigan ambulatory surgery centers, or ASCs, are facilities where surgeries that do not require hospital admission are performed. ASCs are not rural health clinics, urgent care centers, or physicians’ offices. ASCs treat only patients who have already seen a health care provider and selected surgery as the appropriate treatment for their condition.
Small Businesses in Your Community
Michigan ASCs are small entrepreneurial businesses that benefit Michigan communities by providing access to reasonably priced surgical care, but also by contributing to the local property and income tax bases and providing service and contributions to community charities. ASCs are family friendly employers that offer flexible work schedules, and good health and retirement benefits to their trained staffs. Michigan ASCs provide over 2,000 direct jobs in Michigan.
Ambulatory Surgery Centers are a Good Choice for Many Reasons
The high level of professionalism, quality and safety Michigan ASCs offer is an important reason patients and physicians choose ASCs for surgical procedures. Low infection rates, high satisfaction, and lower costs are among the reasons patients choose Michigan ASCs. ASCs typically cost less than hospitals for the same procedures, saving the patients a significant amount of money. Physicians choose Michigan ASCs because of the low infection rate, quick room turnover, high patient satisfaction, and efficient boarding and scheduling.
Ambulatory Surgery Centers are positive for the Michigan Economy
By providing high-quality health care and excellent service, Michigan ASCs save patients and insurers money. Medicare and its beneficiaries pay an average 54% more for a procedure performed in a hospital outpatient department than they would pay for the same procedure if performed in a Michigan ASC. Some procedures need to be done in the hospital, but many don’t. That’s why Michigan ASCs are positive for the Michigan economy – they provide a high quality, lower cost alternative for Michiganders.
On Monday, March 4th, 2019, the Metro Health OAM Surgery Center was toured by Michigan State Representatives Lynn Afendoulis (District 73) and James Lower (District 70). Also joining the tour were Dan Papineau, Director of Tax Policy and Regulatory Affairs with the Michigan Chamber of Commerce, Ryan Burtka, Michigan Ambulatory Surgery Center Association (MASA) Lobbyist, and Adam Urber, Legislative Director for Representative Afendoulis.
Representatives Afendoulis and Lower are the Chair and Co-Chair the Tax Policy Committee for the Michigan House of Representatives. On February 20th, Representative Afendoulis introduced House Bill 4203, with the intent of removing the wording “dispensed pursuant to a prescription” from the State of Michigan tax code when referring to surgically implanted devices. This wording has caused medical implants such as plates, screws, anchors, and grafts subject to the 6% Michigan sales tax since July 2018. It was estimated this additional tax could cost Michigan Ambulatory Surgery Centers (ASCs) several million dollars in 2019.
The purpose of the tour at Metro Health OAM Surgery Center (MHOAMSC) was to showcase to the Representatives and guests the quality of care, and level of patient satisfaction, that ASCs offer. In addition, the negative impact on the cost of healthcare that this sales tax generates was discussed. MHOAMSC is an orthopaedic centered facility, providing care for patients throughout Michigan, and performing approximately 5,500 surgeries per year. These surgeries include minimally invasive spine procedures as well as same-day total joint replacements.
The leadership team at MHOAMSC was also able to share with the Representatives and their Guests information regarding how ASCs are able to save Medicare and Medicaid money, by providing the same outpatient services as a hospital, but in a lower cost environment. MHOAMSC’s Executive Director, Tina Piotrowski, spoke on behalf of Michigan ASCs at the Tax Committee hearing on Wednesday, March 6, 2019. Ms. Piotrowski was able to highlight the value that ASCs bring to healthcare as well as the exceptional quality of care provided to patients.
6-5-18 Meeting with US Senator Debbie Stabenow
This is a general and very brief description of the major steps of the legislative process a bill must go through before it is enacted into law.
Bills may be introduced in either house of the Legislature. Senate bills are filed with the Secretary of the Senate and House bills with the Clerk of the House. Upon introduction, bills are assigned a number. At the beginning of each biennial session, House bills are numbered consecutively starting with House Bill No. 4001 and Senate bills are numbered starting with Senate Bill No. 1. In both houses, joint resolutions are assigned a letter.
Under the State Constitution, every bill must be read three times before it may be passed. The courts have held, however, that this requirement can be satisfied by reading the bill’s title. Upon introduction, the bill’s title is read a first and second time in the Senate and is read once in the House. The bill is then ordered to be printed. A bill cannot be passed or become law until it has been printed or reproduced and in the possession of each house for at least five days.
Referral to Committee
Upon introduction, a bill is also referred to a standing committee in the Senate by the Majority Leader and in the House of Representatives by the Speaker of the House. All bills involving an appropriation must be referred either directly to the appropriations committee or to an appropriate standing committee and then to the appropriations committee.
Committee members consider a bill by discussing and debating the bill. The committee may also hold public hearings on the bill.
In the cases of d and e, the bill, upon being reported from committee, is tabled on the floor (temporarily removed from consideration). A majority vote of the members present and voting in the house where the bill is tabled is required to remove the bill from the table before it may be given further consideration.
In both houses, a majority vote of the members serving on a committee is necessary to report a bill. If a committee fails to report a bill, a motion to discharge the committee from consideration of the bill may be offered in the house having possession of the bill. If this motion is approved by a vote of a majority of the members elected and serving, the bill is then placed in position on the calendar for floor action. In the House, at least a one-day prior notice of the motion to discharge must be given to the Clerk of the House.
If a bill is reported from committee favorably with or without amendment or in the form of a substitute bill, the committee report is printed in the journal under the order of business entitled “Reports of Standing Committees” in the House. On being reported favorably from committee, the bill and recommended committee amendments (if any) are placed on the order of “General Orders” in the Senate. In the House, the bill and amendments are referred to the order of “Second Reading.”
General Orders or Second Reading
For the purpose of considering the standing committee recommendations on a bill, the Senate resolves itself into the Committee of the Whole and the House assumes the order of Second Reading. Amendments to the bill maybe offered by any member when the bill is being considered at this stage of the legislative process. In the Senate, a simple majority of members present and voting may recommend adoption of amendments to the bill and recommend a bill be advanced to Third Reading. In the House, amendments may be adopted by a majority serving, and a majority voting may advance the bill to Third Reading. In the House, a bill may be placed on Third Reading for a specified date.
While there are provisions in the House Rules and the Senate Rules for reading bills unless exception is made, in practice, bills are not read in full in either chamber. In both houses, amendments must be approved by a majority vote of the members serving and the previous question maybe moved and debate cut off by a vote of a majority of the members present and voting. At the conclusion of Third Reading, the bill is either passed or defeated by a roll call vote of the majority of the members elected and serving (pursuant to the State Constitution, approval of certain measures requires a “super majority” of a two-thirds or three-fourths vote) or one of the following four options is exercised to delay final action on the bill: (a) the bill is returned to committee for further consideration; (b) consideration of the bill is postponed indefinitely; (c) consideration is postponed until a certain date; or (d) the bill is tabled.
Following either passage or defeat of a bill, a legislator may move for reconsideration of the vote by which the bill was passed or defeated. (A motion to reconsider can be made for any question.) In the Senate, the motion for reconsideration must be made within the following two session days; in the House, the motion must be made within the next succeeding session day.
No bill can become law at any regular session of the Legislature until it has been printed and reproduced and in the possession of each house for at least five days. (Constitution, Art. IV, Sec. 26.)
No act shall take effect until the expiration of 90 days from the end of the session at which the measure was enacted. The Legislature may give immediate effect to an act by a two-thirds vote of the members elected and serving in each house. (Constitution, Art. IV, Sec. 27.)
Enactment by the Legislature
If a bill passes, it is sent to the other house of the Legislature where the bill follows the procedure outlined above, resulting in defeat or passage.
If a bill is passed by both houses in identical form, the bill is ordered enrolled by the house in which the bill originated. Following enrollment and printing, the bill is sent to the Governor.
MASA, your association, has the opportunity to participate more effectively in the political process in Michigan. MASA has formed a political action committee, MASAPAC. MASAPAC is the latest tool for our efforts to advance the interests of the ASC Industry. MASAPAC will inform its members about important issues and decisions made by government officials that can affect the ASC industry. The committee will also provide an opportunity for members to jointly support public policy positions that are important to our industry in Michigan.
MASAPAC is a bipartisan organization that contributes to the campaigns of state and local candidates. MASAPAC typically supports candidates who share MASA’s views on public policy, serve as legislative leaders, represent districts where MASA has a major business presence, or serve on committees that have jurisdiction over legislation that is important to our industry.
I hope you will support your political action committee by making a donation. Checks of $100, $50 or even $25 should be made payable to MASAPAC. Please download the contribution form below. Thank you.