AS I SEE IT
Advancing the ASC Advocacy Agenda in 2013 Help ASCA further your cause by getting involved. BY NAP GARY
As 2013 begins and our newly elected Congress convenes, ASCA is con- tinuing to fight for the policy changes needed to
support and expand patient access to the high quality, cost-effective care that ASCs provide. Our priorities for this year range from very specific patient care initiatives to very broad efforts to strengthen ASCs’ position within the health care system.
Accountable Care Organizations and Consolidation Last year’s Supreme Court decision that upheld most of the key provisions of the Patient Protection and Affordable Care Act also enabled the continued growth of the accountable care organi- zations (ACOs) defined in that law. At the same time that these new alliances are being formed across the country, hospitals and health systems are em- ploying physicians in record numbers, purchasing independent ASCs and test- ing new ways of providing insurance to those who live and work in their com- munities. What does all of this mean for ASCs, patients and insurers? In a US House Ways and Means Health Subcommittee hearing on health care consolidation in September 2011, then Subcommittee Chairman Wally Herger (R-CA) noted that consolidation might lead to greater efficiencies and better outcomes, but also often resulted in higher prices. Consolidation, he add- ed, could also result in unnecessarily higher Medicare costs by enabling cer- tain providers to receive higher Medi- care reimbursements simply by chang- ing their affiliation. During testimony that he present- ed at that hearing on ASCA’s behalf, ASCA Vice President Michael Gua- rino expressed concern that consoli-
8 ASC FOCUS JANUARY 2013
dation could lead to anti-competitive behavior and monopolies in certain markets, and ultimately, funnel pa- tients into higher cost settings. He pointed out that although ASCs were saving Medicare $2.5 billion each year, the growing disparity in ASC and hospital outpatient department (HOPD) payment rates is encouraging hospital purchases of ASCs, thereby raising overall costs in the health care system. If just 50 percent of the cases performed in HOPDs today were per- formed in ASCs instead, he added, Medicare would save an additional $20 billion over 10 years.
In response to the pressures that consolidation and ACOs are exerting on ASCs, patients and others, some of the specific policy and regulatory initiatives that ASCA will support this year include: ■
Implementing transparent quality and price reporting across settings to bet- ter inform patients about their treat- ment options;
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Ensuring that ASC payment updates keep pace with updates for the same services provided in hospitals (espe- cially since ASCs and hospitals con- front the same inflationary challeng- es of hiring and retaining nurses and purchasing medical supplies); and
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Exercising rigorous oversight of ACOs to ensure that they do not hinder com- petition and lead to higher costs.
Physician Discharge Requirements Medicare regulations currently require a patient’s surgeon to sign a discharge order indicating that the patient is medi- cally cleared to go home before the pa- tient is allowed to leave the ASC. CMS’ Guidance for Surveyors: Ambulatory Surgery Centers states that the dis- charge order must be signed within 15– 30 minutes of the patient’s departure.
Typically, surgery patients are not ready to go home immediately after they are medically cleared to do so. Instead, they must wait for the effects of anesthe- sia to wear off, which can take more time. It is, however, the patient’s anesthesiolo- gist—not the surgeon—who monitors this process and makes the final deter- mination that the patient has recovered sufficiently from anesthesia to be able to return home safely. Because the cur- rent regulations require surgeons to sign a discharge order within 30 minutes of the time the patient leaves the facility, the surgeon must remain in the ASC, even though he or she has nothing to contrib- ute to the anesthesia recovery process. Keeping surgeons at ASCs when
they have no reason to be there is an inefficient use of their time and health care resources. They could be seeing patients in their office or providing coverage at the hospital. Additionally, since surgeons typically place a high value on their time, requiring surgeons to spend time waiting at an ASC, rather than providing patient care, could en- courage them to perform procedures in the higher cost hospital setting, where they do not have to wait after they medically clear a patient. Illogical pol- icies like these that favor HOPDs over ASCs limit patient choice, unfairly re- strict competition and increase costs. For these reasons, ASCA will work to change this federal regulation to be consistent across all settings. Alternatively, we will work for changes in the Guidance for Survey- ors: Ambulatory Surgery Centers that would remove the expectation that pa- tients must leave the ASC within a spe- cific amount of time after the physician signs the order that medically clears a patient for discharge.
Additions to Medicare’s List of Allowable Procedures Currently, in the Medicare program, approximately 366 procedures that can
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