ASCs say bring it on

Cen­ters see re­quired re­port­ing as aid­ing their case

Modern Healthcare - - The Week In Healthcare - An­dis Robeznieks

Hos­pi­tals have been seek­ing more reg­u­la­tion and pub­lic re­port­ing re­quire­ments from am­bu­la­tory surgery cen­ters, but ASC back­ers say hos­pi­tals should be care­ful about what they wish for. Fi­nan­cial-, safety-and qual­i­tyre­port­ing re­quire­ments could help con­firm ASC boasts that they can per­form sur­gi­cal pro­ce­dures bet­ter and at a lower cost.

Ac­cord­ing to the Na­tional Con­fer­ence of State Leg­is­la­tures, ASCs in Colorado, Mis- souri, Penn­syl­va­nia and Texas al­ready are re­quired to re­port their in­fec­tion rates. Ear­lier this month, New Jer­sey be­came the fifth state to make this re­quire­ment and, at a Jan. 14 meet­ing of the Medi­care Pay­ment Ad­vi­sory Com­mis­sion, fed­eral qual­ity re­port­ing re­quire­ments were mulled as well.

In his last days in of­fice, New Jer­sey Gov. Jon Corzine signed some 55 bills into law, granted clemency to 14 peo­ple, and ap­pointed sev­eral friends and al­lies to var­i­ous state boards. While the ap­point­ments and a law per­mit­ting the med­i­cal use of mar­i­juana re­ceived most of the at­ten­tion, his sign­ing of a bill re­quir­ing ASCs to fol­low uni­form billing and in­fec­tion re­port­ing stan­dards that “to the ex­tent pos­si­ble, meet the same data re­quire­ments that ap­ply to hos­pi­tals” did not gain much no­tice.

The New Jer­sey Hospi­tal As­so­ci­a­tion sup­ported the bill, and NJHA spokes­woman Kerry McKean Kelly said the new law grew out of a 2007 re­port cre­ated by a com­mis­sion on health­care re­sources that rec­om­mended “lev­el­ing the play­ing field” among dif­fer­ent providers. “The bot­tom line is trans­parency,” she said, ac­knowl­edg­ing that the pub­lic re­port­ing may give ASCs some pos­i­tive pub­lic­ity in com­par­i­son with hos­pi­tals.

Pub­lic re­port­ing “helps us learn where we need to im­prove,” she said. “When you en­dorse trans­parency, you take the good with the bad.”

Larry Trenk, pres­i­dent of the New Jer­sey As­so­ci­a­tion of Am­bu­la­tory Surgery Cen­ters, said ASCs and other al­ter­na­tive providers have been seen as “the cul­prits” be­hind hospi­tal clos­ings in the state, so hos­pi­tals are push­ing for more reg­u­la­tion of ASCs as a way of im­ped­ing their growth. “This is ob­vi­ously a way for hos­pi­tals to slow down the pro­lif­er­a­tion of cen­ters,” said Trenk, who is also the chief op­er­at­ing of­fi­cer of Surgem, an Oradell, N.J.-based com­pany that op­er­ates ASCs in Florida, New Jer­sey and New York. “I think we’ve done a pretty good job of polic­ing our­selves, but I don’t see this as a bur­den—I see it as an op­por­tu­nity.”

Trenk said the im­ple­men­ta­tion of this law will val­i­date ASC claims of of­fer­ing sur­gi­cal pro­ce­dures with bet­ter out­comes and a lower cost than hos­pi­tals. “I think the num­bers will pos­i­tively re­flect the ex­pe­ri­ence we’ve had and will demon­strate to the pub­lic that surgery cen­ters are prefer­able providers,” he said, adding that New Jer­sey ASCs are reg­u­larly in­spected as a li­cens­ing re­quire­ment and are sub­ject to an am­bu­la­tory-care tax—so the state al­ready had a clear view of their rev­enue pic­ture.

He also said that Surgem and other ASCs reg­u­larly track in­fec­tion and qual­ity data, so the new state re­quire­ment—and any­thing the fed­eral gov­ern­ment may ask for—shouldn’t be too much of a bur­den to pro­vide.

“It’s part of the fab­ric of what we do, and most of the cen­ters I know do like­wise,” Trenk said. “The only dif­fer­ence is it will be re­ported ex­ter­nally as well as in­ter­nally.”

At the Jan. 14 MedPAC meet­ing, it was noted that ASCs are less ex­pen­sive and ex­pand­ing their use among Medi­care ben­e­fi­cia­ries could lower costs for the CMS, but there was also con­cern that it could lead to a higher vol­ume of pro­ce­dures per­formed. MedPAC Se­nior An­a­lyst Dan Zabin­ski said 3.3 mil­lion Medi­care ben­e­fi­cia­ries re­ceived $3.1 bil­lion worth of care at ASCs in 2008. He added that 90% of ASCs had some de­gree of physi­cian own­er­ship, and his col­league Ariel Win­ter noted how “the avail­able ev­i­dence shows that ASCs are less likely to treat Med­i­caid pa­tients than hospi­tal out­pa­tient de­part­ments.”

Win­ter cited a 2005 Med­i­cal Group Man­age­ment As­so­ci­a­tion sur­vey that found that Med­i­caid pa­tients ac­counted for only 4% of ASC pa­tient vol­ume while Medi­care and com­mer­cial plans ac­counted for 87%. He also cited a March 2008 Health Af­fairs re­port that said physi­cians in Penn­syl­va­nia re­ferred more than 90% of their Medi­care pa­tients to an ASC rather than a hospi­tal com­pared with 55% of their Med­i­caid pa­tients.

ASCs will re­ceive a 1.2% Medi­care pay­ment in­crease in 2010 and Zabin­ski rec­om­mended a 0.6% in­crease for 2011. He also sug­gested that, in­stead of bas­ing pay­ment in­creases on the con­sumer price in­dex, Congress should re­quire a ran­dom sam­ple of ASCs to sub­mit cost data and that all ASCs should be re­quired to sub­mit qual­ity data.

Kathy Bryant, pres­i­dent of the Am­bu­la­tory Surgery Cen­ter As­so­ci­a­tion, said her or­ga­ni­za­tion sup­ports a law that would re­quire ASCs to col­lect qual­ity in­for­ma­tion. She said the law is al­ready on the books but isn’t ex­pected to be im­ple­mented un­til next year. “We sup­port hos­pi­tals and ASCs re­port­ing the same data,” she said. “But, in our view, if you’re go­ing to re­port health­care in­for­ma­tion, it should be in­for­ma­tion that is mean­ing­ful and that the pub­lic can un­der­stand.” And, while ag­gre­gated data com­par­ing hos­pi­tals as a whole to ASCs as a whole may be use­ful to pol­i­cy­mak­ers, Bryant said, pa­tients want to be able to com­pare a par­tic­u­lar hospi­tal with a par­tic­u­lar ASC.

Bryant added that she was gen­er­ally sup­port­ive of states serv­ing as lab­o­ra­to­ries in find­ing the best way to ap­proach a prob­lem. For ex­am­ple, in Ne­vada six cases of hepati­tis C were linked to one ASC in 2008 and led to a state in­spec­tion of its 48 ASCs. It also led to a new state law passed last year.

“One of the things they did was to re­quire ASCs to be ac­cred­ited and have an­nual in­spec­tions—in­stead of re­port­ing in­fec­tions af­ter the fact,” Bryant said.

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