Centers that perform cataract, endoscopy, colonoscopy, and laser eye surgery could soon be paid on the basis of quality measures under a plan unveiled by the U.S. Department of Health and Human Services.
Medicare beneficiaries are increasingly receiving services at ambulatory surgical centers, whose numbers are growing by nearly 4% a year, to 5,175 in 2008. That year, these centers administered 5.6 million procedures to 3.3 million beneficiaries, the agency said in a recent report to Congress. ASCs received $3.1 billion from Medicare that year, nearly 10% higher than what they were paid in 2007.
Nevertheless, Medicare "does not require ambulatory surgical centers (ASCs) to collect, report, and validate cost and quality data to determine resource consumption and associated clinical outcomes," the agency said. That is about to change sometime in fiscal year 2012.
A value-based purchasing program for ASCs, similar to those outlined for inpatient and outpatient hospital care, is on the way, the agency said. "CMS intends to propose in CY 2012 rulemaking implementing an ASC quality measure reporting program under section 109(b) of the
Medicare Improvements and Extension Act of 2006," it said.
New VBP rules for ASCs based on performance, however, require several steps. Among these, the HHS Secretary needs statutory authority from Congress to establish a VBP program and allow for performance-based payments. At present, the law "permits the Secretary to implement a quality reporting system for ASCs in a manner so as to provide for a reduction in any annual update for failure to report on quality measures. However, the authority limits the Secretary to reducing the annual update for failure to report – not based on performance."
Second, new quality measures are needed to expand the set now available.
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."
The HHS report to Congress mentions that the Medicare Payment Advisory Commission in 2010 expressed its concern to Congress with "further postponing the implementation of ASC Medicare quality data reporting."
It said, "in recent years, ASCs have rapidly become a critical component of the U.S. healthcare system by improving access to care and providing surgical procedures.
MedPAC also said it would be "technically feasible without imposing an undue administrative burden to begin quality data reporting in 2010. In addition, MedPAC concluded that ASCs have the technical capacity to report on facility-level quality measures which the ASC Quality Collaborationsupports and have the endorsement of the National Quality Forum."
The HHS report to Congress lists the top 20 surgical procedures by volume at ASC in 2009. Nearly one-third, 32.1% dealt with the eye, such as laser surgery on the eye or cataract surgery, and nearly another third, 32.7% involved gastrointestinal procedures such as colonoscopies or upper GI endoscopies and biopsies. Nervous system procedures comprised 19%, musculoskeletal procedures 6.6% and genitourinary surgeries, 3.7%.