were not included in the SUPPORT for Patients and Communities Act: ■■

Post-Surgical Injections as an Opi- oid Alternative Act, which would have frozen several post-surgical pain management codes in the ASC setting at their 2016 reimbursement rates for four years.

Postoperative Opioid Prevention Act, which would have encouraged the use of non-opioid analgesics in post-surgical pain treatment. CMS included the latter provision in the OPPS/ASC Payment System Final Rule. This will establish sepa- rate payment for certain non-opioid pain management treatments. Cur- rently, CMS’ definition applies only to one non-opioid, Exparel, but it is expected to fit new opioid alternatives in the future. ASCA supported this provision in CMS’ rule and submitted the following public comments: ASCA strongly supports the Admin-


istration’s efforts to combat the opi- oid epidemic and encourages CMS to adopt its proposal to unpackage and pay separately for the cost of non-opi- oid pain management drugs that func- tion as surgical supplies when they are furnished in the ASC setting. As the Agency states in this rule, due

to the large disparity in payment rates between HOPDs and ASCs, “fluctua- tions in payment rates for specific ser- vices may impact these providers more acutely than hospital outpatient depart- ments, and therefore, ASCs may be less likely to choose to furnish non-opioid postsurgical pain management treat- ments, which are typically more expen- sive than opioids, as a result.” Research shows that EXPAREL— the only product that CMS has iden- tified

as meeting the requirements

of the new proposal—has many ben- efits, including a reduction in post- operative pain reported by patients and most pertinent to this proposal, a reduced need for opioids. Importantly, in 2018, Congress also passed the VA Maintaining Sys-


to VA of any care or services fur- nished, including prescriptions. Finally, in early 2018, ASCA’s Board of Directors endorsed a position state- ment to help build awareness of the opi- oid crisis and non-opioid alternatives: Despite significant reductions of opioid-based

in the prescription

ASCs play an important role in innovating health care delivery and non- opioid treatments. ASCA steadfastly advocates opioid alternatives to pain management and will continue to empower its members to deliver advanced and safe outpatient surgery”

— Jeff Evans, ASCA

tems and Strengthening Integrated Outside Networks (MISSION) Act to reform the Veterans Health Adminis- tration. Following are opioid-related provisions included in that legisla- tion, which President Trump signed in June: ■■

As part of a training program to administer non-Veterans Administra- tion (VA) health care, VA employees and contractors must study opioid prescription management to ensure safe opioid prescribing practices;

VA must implement a process for community providers to have access to available medical history of a patient, including prescriptions; and


Community care providers are required to submit medical records

medications, ASCA believes the cur- rent crisis requires the medical com- munity to do more to seek alternative means of reducing their use for pain management. For outpatient surgery, this could include greater use of such innovations as longer lasting analge- sics and pain pumps. As the leading representative and advocate for ambulatory surgery cen- ters, ASCA provides members with educational resources on a wide range of regulatory, compliance and safety protocols and guidelines. While ASCA does not perform a

regulatory or governance role for medical professionals it can—and will—continue to use its


leadership position and educational capabilities to promote and share best practices and medical specialty guidance on the reduction of the use of opioid-based medications. ASCA also supports a comprehen- sive and national response to solving the current crisis through a combi- nation of addiction prevention, early intervention and treatment, disease management and recovery support. ASCs play an important role in

innovating health care delivery and non-opioid treatments. ASCA stead- fastly advocates opioid alternatives to pain management and will continue to empower its members to deliver advanced and safe outpatient surgery. For more information on opioid

legislation and other federal activity, visit or write Jeff Evans at

Jeff Evans is ASCA’s assistant director of government affairs, legislative affairs. Write him at


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