REGULATORY REVIEW
ASC Quality Reporting Program Requirements for 2019 A look ahead BY KARA NEWBURY
With the ASC Quality Reporting (ASCQR) Pro- gram web-based measure deadline of May 15, 2018, in the rearview mirror, it is
time to look ahead to the data that will be reported for the Centers for Medicare & Medicaid Services (CMS) ASCQR Pro- gram in 2019 for 2020 payment determi- nations. It also is a good time to review some of the publicly available data on current measures to determine where ASCs can improve.
There are 10 measures that eligible Medicare-certified facilities must report to avoid Medicare payment reductions in 2020. As a reminder, ASCs that have fewer than 240 Medicare claims—pri- mary plus secondary payer—per year during a reporting period for a payment determination year are not required to participate in the ASCQR Program for the subsequent reporting period for that subsequent payment determination year. This includes all program require- ments, both claims-based measures and measures entered via a web-based tool. Here is a breakdown, by measure, of what is required.
Claims-Based Measures
ASCs must continue to report on mea- sures ASC-1: Patient Burn, ASC-2: Patient Fall, ASC-3: Wrong Site/Side/ Patient/Procedure/Implant and ASC- 4: Hospital Admission/Transfer. These claims-based measures are entered as G-codes on the CMS-1500 claim form. Results are reported as a rate per 1,000 cases. Nationwide, performance on these measures is extremely high, and ASCs even saw improvement for all four mea- sures between 2015 and 2016. Measure ASC-1 ASC-2 ASC-3 ASC-4
2015 2016 0.181 0.152 0.095 0.078 0.022 0.020 0.410 0.359
There are 10 measures that eligible Medicare-certified facilities must report to avoid Medicare payment reductions in 2020.”
—Kara Newbury, ASCA CMS may eventually determine ASCs
have “topped out” on these measures, meaning there is little room for improve- ment. This is why ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing and ASC-6: Safe Surgery Checklist Use were removed from the ASCQR Program.
Web-Based Measures ASC-8: Influenza Vaccination Coverage among Healthcare Personnel data col- lection will take place for the influenza season between October 1, 2018, and March 31, 2019, with a reporting dead- line of May 15, 2019. To report ASC-8 through the National Healthcare Safety Network (NHSN) as required, some- one from your ASC must be registered with NHSN. Failure to report on this measure continues to be the number one reason facilities do not receive their full pay- ment update. Compliance has improved
24 ASC FOCUS JUNE/JULY 2018 |
www.ascfocus.org
slightly, up from 74.62 percent in 2014– 2015 to 77.54 percent in 2016–2017. From a CMS perspective, there is still room for improvement. On a recent webinar, CMS contractors indicated that the main issues impacting success- ful reporting are: facility not enrolled in time; staff turnover; incorrect or miss- ing CMS Certification Number (CCN); and a failure to add a reporting plan for the current flu season. ASC-9: Endoscopy/Polyp Surveil-
lance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients and ASC-10: Endoscopy/ Polyp Surveillance: Colonoscopy Inter- val for Patients with a History of Adeno- matous Polyps – Avoidance of Inappro- priate Use are web-based measures that are reported via QualityNet. This aggre- gate data must be reported by all Medi- care-certified ASCs, regardless of spe- cialty or case mix. If your center does
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