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Value-Based Payment Rules May Be Bound for ASCs

Cheryl Clark, for HealthLeaders Media, April 20, 2011

Among some of the specifics, it may reduce annual payment updates "for failure (of an ASC) to report on quality measures" and structure payments based on the centers' rates of the following types of events:

1. A patient burn.
2. A patient fall.
3. Wrong site, wrong side, wrong patient, wrong procedure or wrong implant.
4. Appropriate timing of intravenous prophylactic antibiotic.
5. Appropriate hospital transfer and/or admission.
6. Appropriate surgical site hair removal.
7. Surgical site infection.
8. Medication administration variance.
9. Medication reconciliation; and
10. Venous thromboembolism measures: outcome/assessment/prophylaxis.

In its report, which HHS was required to prepare according to the Patient Protection and Affordable Care Act, CMS highlighted the importance of reducing these errors in light of the fact that these ambulatory care facilities are the fastest growing type of hospital reimbursed by Medicare.

But, it added, there is increasing concern about quality lapses at ASCs, such as increased rates of infections at some facilities.

For example, the report said, in 2008, a large healthcare-associated infection outbreak in two Nevada-based ASCs "exposed over 50,000 former ASC patients to Hepatitis C and other infectious diseases. Reportedly, over 100 people developed Hepatitis C as a result of their exposure in the ASCs," the report said.

"Federal regulators inspected 28 Nevada ASCs for compliance with Medicare standards and subsequent findings revealed 64 percent had serious problems, primarily in infection control," the report said.

ASCs in Maryland, Oklahoma, and North Carolina experienced "common lapses in infection control" as well, the report said. In a pilot study, 12 of 68 ASCs had lapses identified in 3 or more of the five infection control categories" including failure to adhere to recommended practices regarding equipment processing and lapses in handling blood glucose monitoring equipment.

In its report, CMS and HHS said they are creating a "roadmap" for implementation that is likely to use a phased-in timeframe "to minimize the financial and administrative burden associated with designing and implementing such a plan."

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