Policy Priorities
Increasing Transparency. In May 2010, the ASC Advocacy Committee testified before Congress in support of legislation that would provide Americans access to important information related to the price and quality of health care services and settings. Chris Holden, Member of the Ambulatory Surgery Center Advocacy Committee board and President and CEO of AmSurg, an ASC management company, delivered remarks at the House Energy and Commerce Committee hearing on Capitol Hill in support of the “The Patients’ Right to Know Act” (H.R. 4803). Introduced by Representatives Joe Barton (R-TX) and Bart Stupak (D-MI), the bill aims to increase consumers’ ability to make decisions about their health care by presenting meaningful data on the price and quality advantages of services provided by hospitals and ASCs. Read more.
Read the policy brief about ASCs.
Read the policy brief about ASCs Commitment to Quality.
Read the policy brief about the value of Physician Ownership.
Closing the Payment Gap. With tremendous pressure on Congress to control healthcare costs, it will be critical to maintain and enhance the migration of services from the higher-priced hospital outpatient departments (HOPDs) to ASCs. ASCs are often the most cost-effective solution for surgical procedures for both patients and payors, including the taxpayers who fund the Medicare program. If the gap between HOPD and ASC payments is too wide, the cost-saving migration could cease or even reverse.
Despite ASCs’ role in creating savings for the healthcare system, Congress prohibited the Medicare program from increasing ASC payment rates for the past six years. As a result, the relationship between ASC and HOPD payments fell from 86 in 2004 to 57 percent for identical services in 2011. The 1.2 percent update in 2010 did not narrow the gap between the ASC and hospital payments. The 2011 proposed payment rule does not better align the ASC and HOPD payment systems and the rates paid under the two systems and ensuing payment gap will continue to grow in the coming years. This increasing separation between rates will jeopardize facilities’ ability to recruit and retain a skilled workforce, keep pace with technological advancements, implement electronic health records, and comply with increasingly complex regulations.
Payment updates to HOPDs are currently based on the hospital market basket, while, for years, payment updates to ASCs have been based on the Consumer Price Index for all Urban Consumers (CPI-U). ASCs are the only healthcare facilities that receive payment updates based on CPI-U, a measure of inflation for goods and services purchased by consumers, based largely on prices for energy and housing. Unlike the CPI-U, the market basket is a measure of inflation for the goods and services purchased by healthcare facilities. To ensure that ASCs are able to continue to provide high-quality, cost-efficient, patient-centered care, it is important that policymakers establish an update based on the hospital market basket to reflect the real increases in the prices of goods and services which ASCs need.
In March 2010, the Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress acknowledged that the CPI-U is an inaccurate mechanism for updating ASC payments. However in their 2011 proposed rule, CMS failed to act on important recommendations from the ASC, physician community and MedPAC to better align the ASC and HOPD payment systems to prevent the rates paid under the two systems from drifting further apart in the coming years. In addition, bipartisan groups of members in the House and Senate wrote to CMS to urge the agency to link ASC payments to the hospital market basket.
To learn more:
Read the policy brief on the ASC Quality and Access Act.
Download the bipartisan Senate letter to CMS urging the agency to update the ASC payment system.
Read about the 7 Important Issues Affecting ASCs in the CMS Proposed Payment Rule.
Conditions for Coverage. CMS developed Conditions for Coverage (CfCs) as guidelines to determine which procedures, services and settings are covered under the Medicare and Medicaid programs. CMS regularly evaluates and updates the conditions for coverage across all health care settings, although the ASC criteria had not been modified since 1982.
In 2007, CMS proposed revisions to the ASC CfC. In the rule, CMS proposed that “The ASC must provide the patient or the patient’s representative with verbal and written notice of the patient’s rights prior to furnishing care to the patient and in a language and manner that the patient or patient representative understands.”
ASCs supported the proposal to provide patients with the appropriate notices in a form and manner that patients understand. However, the final rule published in 2008 revised the CfC in a manner, that disrupts patient care and can often also come as an inconvenience to patients. The CMS rules require ASCs to provide certain information to patients the day prior to their procedure, a policy inconsistent with the standards applied to hospitals and physician offices where procedures approved for ASCs can also be performed.
In June 2010, the ASC industry delivered another comment letter with recommendations for appropriately revising the CfCs to contribute to the patient-centered environment at ASC facilities and to help to align ASC CFCs with those for hospitals and physician offices.
Dowload the ASC letter to CMS in response to proposed changes to their Conditions for Coverage.
