Some executives in the ambulatory surgery center industry say they are skeptical that new proposed conditions for Medicare coverage announced last week will do much to improve patient care, though hospital industry executives support the CMS changes.
Regardless, ASC executives say they are confident they could meet the new conditions if enacted.
The CMS proposed rule last week updating the conditions that ASCs must meet in order to participate in Medicare is considered the largest overhaul since 1982, the year that the ASC Medicare benefit was established.
The proposed rule would add a number of new requirements. As part of an effort to expand infection-control requirements, the CMS is proposing that ASCs be required to have an infection-control officer, a move that seems like overkill to one industry executive.
Hospitals have infection control officers, and patients still acquire infections in hospitals, said Kathy Bryant, president of FASA, the largest ASC trade group in the U.S. While an officer may be needed in a hospital environment that has thousands of employees, it may not be as necessary in an ASC that has only 20 employees. Everyone in an ASC knows who to go to in the event of an infection, she said.
This is something the American Hospital Association has been pushing for, but it may not necessarily enhance care, Bryant said.
Carmela Coyle, senior vice president for policy with the American Hospital Association, countered that an infection can occur in any setting: hospital, ASC, physician office. Its a part of healthcare and something that all of us have to be vigilant of to prevent from happening.
Another questionable provision, Bryant said, is a requirement that ASCs give patients a description of their states law on advance directives or living wills. Advance directives are legal documents that enable patients to convey their decisions about end-of-life care. ASCs may not be the best source (of) information about advance directives, and theyre telling ASCs we need to give patients legal advice.
In other provisions, the CMS proposes to add a comprehensive patient-assessment requirement to ensure safe surgery at ASCs. Coyle said that the proposed rule could have gone even further in addressing the qualifications of some of these free-standing facilities to handle emergency conditions. Patients need to be clear on what the ASC can and cant do, and the expertise they do and dont have, she said.
The CMS rule would add new requirements for radiology services to ensure they are parallel to the requirements for furnishing laboratory services, and seeks a more comprehensive quality assessment and performance-improvement program.
New patient-rights conditions would address disclosure of physician financial interests in the ASC, as well as the grievance process and confidentiality of clinical records. There would also be a new disaster preparedness plan standard to address emergency preparedness within ASCs.
The American Association of Ambulatory Surgery Centers praised the proposed changes. AAASC is delighted that CMS has proposed improvements in the Medicare conditions for coverage that reflect standards of practice that most ambulatory surgery centers already address, said Craig Jeffries, the AAASCs executive director.
ASCs have been subject to a number of changes to their payment system under Medicare in recent months. In July, the agency issued a series of rules that set a new compensation rate of 65% of what hospital outpatient departments get paid under Medicare (July 23, p. 6). The rulemaking also expanded the list of procedures ASCs could get paid for under Medicare.
Jeffries believes the new conditions of coverage should eliminate many of the regulatory oversight concerns raised by the AHA and others. These standards of practice together with the outstanding experience of ASC measured by core outcomes that will begin to be collected by CMS in 2009 address the quality elements that underscore the value of ASC for Medicare beneficiaries looking for expanded access to high-quality, lower-cost and patient-centered procedures.