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REGULATORY REVIEW


the regulatory groundwork that we grapple with today.


A vital component of the HITECH


Act involved codifying definitions; the act starts with definitions for terms including “certified EHR technology” and “health information technology.” The HITECH Act is also the advent of the term “meaningful use,” the industry- standard term for the program designed to incentivize physicians and hospitals to implement and use EHRs. Only EHRs up to a certain standard indicate mean- ingful use, and responsibility for setting such standards was given to ONC who established the ONC Health IT Certifi- cation Program in 2010. Through this program ONC has released three cer- tification criteria editions—2011, 2014 and 2015—which contain technical standards and implementation specifi- cations against which individual prod- ucts can be measured. In 2015, pursuant to the Medicare Access and CHIP Reauthorization Act (MACRA) the Centers for Medicare & Medicaid Services (CMS) folded the physician meaningful use program into the Quality Payment Program (QPP), a new, overarching value-based payment system that would adjust physician pay- ments based on scoring in four perfor- mance categories [Note: The QPP does NOT affect ASC facility payments in any way]. 2018 will be year two of the transition into the QPP.


EHRs in ASCs


At this time, there is no ASC-specific EHR certification. While some ASCs use EHRs in their facilities, ONC still certifies only products designed for use in either a hospital or physician office. This burdens clinicians who primarily operate in ASCs but treat enough Medi- care patients to be eligible for payment adjustments (± 4 percent in 2019 ris- ing to ± 9 percent by 2022) under the QPP. To combat this burden, Congress included Section 16003 in 2016’s 21st Century Cures Act, which states that no payment adjustment related to mean-


34 ASC FOCUS MAY 2018 | www.ascfocus.org


It would be a mistake for ASCs, however, to disregard EHRs entirely, as both the industry at large and regulatory forces are increasingly marshalling to push all sites of service toward adopting HIT.”


—Alex Taira, ASCA


ingful EHR use will be made for eligi- ble professionals who furnish “substan- tially all” of their services in an ASC. The definition of “substantially all” was clarified in the CY 2018 Inpatient Pro- spective Payment System (IPPS) Final Rule; an ASC-based eligible profes- sional is one who furnishes 75 percent or more of covered professional ser- vices in an ASC setting. Originally seen as a win for ASCs,


this exemption has had some unintended consequences. The QPP folded physi- cian meaningful use into the Merit-based Incentive Payment System (MIPS), spe- cifically into the Advancing Care Infor- mation (ACI) performance category, which comprises 25 percent of a physi- cian’s performance score. That score, in turn, determines the physician’s overall payment adjustment. In Section 16003


Track the Latest Regulatory and Legislative News for ASCs


Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.


www.ascassociation.org/ GovtAffairsUpdate


of the 21st Century Cures Act, CMS exempts ASC-based clinicians from the ACI category and moves the ACI score to the Quality category. Consequently, the Quality category, already the largest weight under normal scoring, is respon- sible for 75 percent of an ASC-based clinician’s total score. This creates obvi- ous disadvantages for surgeons who provide care to most of their patients in ASCs, including capturing a narrower range of clinician performance in over- all score, forcing clinicians to report comparatively burdensome measures and providing a less accurate assess- ment of ASC-based clinicians com- pared to other sites of service.


Toward an ASC-Specific EHR Certification Last July, ASCA convened a group of stakeholders from within the ASC com- munity to discuss advocacy and educa- tion regarding EHRs in ASCs. The group holds monthly calls that cover pertinent legislative and regulatory changes and provides an avenue to generate educa- tional opportunities, resources and gen- eral discussion. A smaller workgroup, comprising ASCA staff, vendor affiliates and member representatives, also meets monthly and is actively working toward creating a voluntary, ASC-specific EHR certification. This certification would provide a baseline for EHR vendor sys- tem development and allow ASCs to par- ticipate in new, value-based care models. As this publication goes to press, rep- resentatives from ASCA and the work- group have had two meetings with ONC leadership, including National Coordi- nator Don Rucker, MD, to discuss a pro- spective ASC-specific certification. For more information about HIT reg- ulation and EHRs in ASCs or to inquire about participation in ASCA’s EHR Stakeholder Group, reach out to Alex Taira at ataira@ascassociation.org.


Alex Taira is ASCA’s policy analyst. Write him at ataira@ascassociation.org.


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