As we race toward the end of year, Surgical Notes looks back at seven of
the top developments affecting the ASC industry in 2017.
1. Implementation OAS CAHPS delayed. One of the biggest developments from the Centers for Medicare & Medicaid
Services' (CMS) 2018 Hospital Outpatient Prospective Payment System
(OPPS) and Ambulatory Surgical Center Payment System final rule was the
delay of the mandatory implementation of the Consumer Assessment of Healthcare
Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS).
OAS CAHPS is designed to measure the experiences of care for patients who
visit a Medicare-certified ASC (or hospital outpatient department) for
a procedure. If implementation becomes mandatory, ASCs that fail to participate
and comply with OAS CAHPS could lose 2% of their annual Medicare payment
update. The delay finalized in the 2018 calendar year (CY) final rule
specifically applies to the 2018 data collection, which is connected to
2020 payment determination.
CMS noted it plans to continue the voluntary participation period for OAS
CAHPS throughout 2018. The next update, to be included in the CY 2019
rule, will be proposed in July 2018 and finalized in November 2018. The
CY 2019 rule will reflect any changes that would impact the 2019 data
collection period (CY 2021 payment determination).
2. Addition and removal of ASCQR measures. Several modifications made to ASC Quality Reporting (ASCQR) Program measures
signify another noteworthy development. ASCs that meet ASCQR Program requirements
during a given CY receive their full payment update for the upcoming CY.
ASCs that do not participate or fail to meet those requirements may receive
a 2% reduction of their Medicare payment update.
CMS finalized the addition of two measures of hospital events following
specified surgical procedures to the ASCQR Program measure set for the
CY 2022 payment determinations and subsequent years. The measures finalized
for addition are:
- ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures,
which assesses all-cause, unplanned hospital visits within seven days
of an orthopedic procedure performed at an ASC (beginning with the CY
2022 payment determination).
- ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures,
which assesses all-cause, unplanned hospital visits occurring within seven
days of the urology procedure performed at an ASC (beginning with the
CY 2022 payment determination).
For these measures, "hospital visits" include emergency department
visits, observation stays, and unplanned inpatient admissions.
CMS finalized the removal of three measures for the CY 2019 payment determination
and subsequent years. They are as follows:
- ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing, which assesses
whether intravenous antibiotics given for prevention of surgical site
infection were administered on time.
- ASC-6: Safe Surgery Checklist Use, which is a structural measure of facility
process that assesses whether an ASC employed a safe surgery checklist
that covered each of the three critical perioperative periods (prior to
administering anesthesia, prior to skin incision, and prior to patient
leaving the operating room) for the entire data collection period.
- ASC-7: ASC Facility Volume Data on Selected Procedures, which is a structural
measure of facility capacity that collects surgical procedure volume data
on six categories of procedures frequently performed in the ASC setting.
3. Removal of total knee arthroplasty from inpatient-only list. In a promising development for ASCs, CMS announced in the 2018 final rule
that it was removing total knee arthroplasty from the Medicare inpatient-only
(IPO) list. This list includes procedures that are typically only provided
in the inpatient setting and are therefore not paid under the OPPS.
While CMS did not add total knee arthroplasty to the ASC list of payable
procedures, its removal from the IPO list would seem to represent an important
step in that direction. Unfortunately, no such action was taken with other
joint replacement procedures, such as partial hip arthroplasty and total
hip arthroplasty. CMS indicated it wanted to engage in further discussion
before making decisions on these procedures.
4. CMS begins surveying revised emergency preparedness standards. In September 2016, CMS finalized a rule issuing new emergency preparedness
requirements for healthcare providers, including ASCs, participating in
Medicare and Medicaid. The objective, according to CMS, was to increase
patient safety during emergencies and establish a more coordinated response
This final rule required Medicare and Medicaid participating providers
and suppliers to meet the following four standards:
- Emergency plan: Based on a risk assessment, develop an emergency plan using
an all-hazards approach focusing on capacities and capabilities that are
critical to preparedness for a full spectrum of emergencies or disasters
specific to the location of a provider or supplier.
- Policies and procedures: Develop and implement policies and procedures
based on the plan and risk assessment.
- Communication plan: Develop and maintain a communication plan that complies
with both federal and state law. Patient care must be well-coordinated
within the facility, across health care providers, and with state and
local public health departments and emergency systems.
- Training and testing program: Develop and maintain training and testing
programs, including initial and annual trainings, and conduct drills and
exercises or participate in an actual incident that tests the plan.
Organizations affected by this rule were required to comply and implement
all regulations by November 15, 2017. As of that date, CMS surveys began
evaluating compliance based on these revised emergency preparedness standards.
5. Local and nationwide impact of multiple hurricanes. The effects of the three major hurricanes that hit the United States —
Irma, Harvey and Maria — were felt well beyond the areas directly
impacted by these disasters.
Considering the potential damage and likely business interruption caused
by the storms, CMS granted exceptions for Medicare quality reporting requirements
to ASCs located in these areas. (Note: CMS took a similar action for ASCs affected by the Northern California
Outside of these areas, the devastation brought by Hurricane Maria to Puerto
Rico caused significant disruption in the production of common IV solutions.
Puerto Rico produces more pharmaceuticals for the United States than any
of the 50 U.S. states or any single foreign country. As an NPR report
noted, the island is home to more than 100 drug and medical device manufacturers.
This includes Baxter, a major supplier of IV bags. The company
reported that its facilities in Puerto Rico suffered some structural damage and
power disruption, leading to multiple days of lost production. Facing
an IV shortage, ASCs, like other healthcare providers, have been forced
to more effectively manage their supplies, seek IV alternatives, and take
other steps to ensure there is enough IV in stock to provide safe care
6. CMS cancels bundled payment initiatives. In a decision that would appear to slow the transition toward value-based
care, CMS announced in late November that it was canceling two mandatory
bundled-payment models and scaling back a third.
CMS finalized the cancellation of the mandatory hip fracture and cardiac
bundled payment models and reduced the number of mandatory geographic
areas participating in the Comprehensive Care for Joint Replacement model
by about half.
7. Powdered glove ban takes effect. In December 2016, the U.S. Food and Drug Administration (FDA) finalized
the banning of powdered surgeon's gloves, powdered patient examination
gloves, and absorbable powder for lubricating a surgeon's glove. The
FDA stated that its decision to finalize the ban was based on the "unreasonable
and substantial risk of illness or injury to individuals exposed to the
As FDA noted, "The risks to both patients and healthcare providers
when internal body tissue is exposed to the powder include severe airway
inflammation and hypersensitivity reactions. Powder particles may also
trigger the body's immune response, causing tissue to form around
the particles (granulomas) or scar tissue formation (adhesions) which
can lead to surgical complications."
The ban became effective January 18, 2017.
What was particularly significant about this ban is that it represented
only the second time the FDA has ever banned a medical device. The first
was prosthetic hair fibers, banned in 1983.
Looking ahead to 2018
2017 was a year full of activity for ASCs, and it is not unreasonable to
expect the same for 2018. What will happen with OAS CAHPS? Is this the
year when total joint replacement procedures are added to the ASC payable
list? How will changes to the Affordable Care Act impact ASCs? Will CMS
finally start updating ASC payments using the hospital market basket rather
than the consumer price index for all urban consumers (CPI-U)?
Surgical Notes will be keeping a close eye on these and other developments
to ensure we are prepared to respond quickly and effectively to any changes
that could affect our clients and their ability to deliver high-quality,