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ASCAQ&A with Kara Newbury and Heather Ashby of the Ambulatory Surgery Center Association (ASCA)

Kara Newbury is the Ambulatory Surgery Center Association’s (ASCA) regulatory counsel. In this position, she spearheads ASCA’s federal regulatory efforts, primarily working with the Centers for Medicare & Medicaid Services (CMS).Heather Ashby is ASCA's director of government affairs. In this position she directs legislative, state, grassroots and political affairs to advance the strategic goals of the association’s policy agenda.

Q: The Medicare 2017 ASC Payment Final Rule and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule were released in the final quarter of 2016. What are the key takeaways of these developments for Medicare-certified ASCs?

Kara Newbury: There were no earth-shattering policy changes in the 2017 ASC payment rule. Rates will increase nominally and ten new procedures were added to the ASC list of payable procedures this year. One change to note is that seven new measures are to be added to the CMS payment determinations in 2020.

Two require data to be submitted directly to CMS via a web-based tool:

  1. ASC-13: Normothermia Outcome - percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU)
  2. ASC-14: Unplanned Anterior Vitrectomy: a procedure performed when vitreous inadvertently prolapses into the anterior segment of the eye during cataract surgery.

Five are based on the use of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS).

  1. ASC-15a: OAS CAHPS – About Facilities and Staff
  2. ASC- 15b: OAS CAHPS – Communication About Procedure
  3. ASC-15c: OAS CAHPS – Preparation for Discharge and Recovery
  4. ASC-15d: OAS CAHPS – Overall Rating of Facility;
  5. ASC-15e: OAS CAHPS – Recommendation of Facility.

Three-hundred completed surveys from patients must be submitted to meet the reporting requirements starting in 2018. These seven reporting criteria will place a substantial burden on ASCs to collect data in order to receive maximum reimbursements from CMS, a burden that many are unequipped to handle.

In 2017, ASCA will continue to advocate for reductions in the length and number of completed surveys required in the 2018 payment rule that will be finalized prior to the full implementation of the OAS CAHPS survey. 

Q: Besides these final rules, what are some of the most significant ASC developments from 2016, and why are they noteworthy for the industry?

Heather Ashby: The passage of the 21st Century Cures Act (Cures), which addressed concerns regarding the use of electronic health records as well as the provision included on price transparency. We have worked for three years on getting a fix for these electronic health record (EHR) meaningful use requirements and penalties for ASC physicians that see the majority of their cases in ASCs. We were pleased to see this year that not only did this legislation pass the House and the Senate, our champions on the House side took it upon themselves to expand the intent of the legislation to apply it through the implementation of the new the Medicare physician payment system.

Originally, the Electronic Health Fairness Act was just applicable to the current penalties of the meaningful use program created by the HITECH (Health Information Technology for Economic and Clinical Health) Act. That version passed the House and Senate with slightly different versions earlier in the year. When Congress was looking at putting a package together at the end of 2016, they updated the language to make it applicable in the new payment system, and they did that of their own accord.

I think this speaks to the strength of the relationships we have built and the growing understanding of the ASC industry by members of Congress and their staff. They understand that ASCs play a vital role in the healthcare system, and they were looking to make sure ASC physicians were not unduly penalized.

Q: What 2016 developments — or other accomplishments — is ASCA most proud of?

HA: We achieved a record number of cosponsors and support in both the House and Senate for the ASC Quality and Access Act. We saw a 16 percent jump in number of cosponsors of our bill this Congress.

On the federal legislative side, such growing support feeds into the larger idea that what we are doing and have been doing for so many years in telling our story through the ASC Quality and Access Act and the other pieces of legislation is working. People are starting to listen, pay attention and understand.

In the case of Cures, we were able to get a piece of legislation ASCA was instrumental in drafting all the way through the process of getting it signed into law. What we are doing advocacy-wise is working.

Public affairs-wise, we worked with HealthSmart and Healthcare BlueBook on a study of what ASCs save the commercial market. We were very pleased to see that, according to the analysis, surgery centers are currently saving about $38 billion and there is another $38-$40 billion on the table of potential savings when looking at different ways of migrating volume into the ASC.

Q: Looking ahead to 2017, what should ASCs be on the watch for?

HA: Incoming Health & Human Services (HHS) Secretary Tom Price is an orthopedic surgeon. Before he came to Congress, he had ownership interests in ASCs in Georgia. He has been one of our strongest and loudest supporters on the Hill. We are eager to see how he builds out his team at HHS. We look forward to seeing how he translates the many policies he has proposed and been an advocate for as a member of Congress into regulatory action.

What little the president-elect has said on healthcare, "repealing and replacing" the Affordable Care Act will be the first item on the agenda. Although doing so does not necessarily immediately affect ASCs, the legislative and political maneuvering may offer several opportunities for us to get legislative proposals that help the ASC industry into these larger efforts.

Any time that Congress or the administration talks about moving major healthcare legislation is an opportunity for ASCA and the industry to educate Congress as they are thinking about healthcare and get our legislative priorities attached to pieces of legislation that are large enough to move.

Q: Finish this sentence: ASCs that will find success in the new year will...

HA: ... engage with their state and federal legislators by participating in ASCA's advocacy activities. They will come to a fly-in, host a facility tour or contact their elected officials about important issues facing the industry. Advocating for your ASC and the ASC industry at large helps everybody. Without the champions that pushed for our EHR provision to be in Cures, it wouldn't have happened. If these guys don't stay in Congress, then they are not there to fight for the legislation that our industry needs to protect and promote ASCs.

This year's fly-in — which we are calling National Advocacy Day — is happening as part of ASCA 2017. It's all wrapped up in one registration package.

ASCs should also be on the lookout for state-level legislation and regulatory changes that could immediately impact them, such as workers' compensation changes, provider taxes and changes to the regulatory definitions. We saw a lot of that in 2016, and expect that trend will continue into 2017.