ASCs say bring it on
Centers see required reporting as aiding their case
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.