A. Background
Section 109(b) of the Medicare Improvements and Extension Act of 2006 gives the Secretary of the United States Department of Health and Human Services (HHS) the authority to implement ASC quality measure reporting and to reduce the payment update for ASCs that fail to report those required measures. Any ASC that does not submit quality measures to the Secretary of HHS will incur a 2.0% reduction to any annual increase provided under the revised ASC payment system for such year.
B. Quality Reporting Program
As part of the proposed rule, CMS has proposed to implement an ASC quality reporting program with eight proposed quality measures to be reported starting January 1, 2012. These, shown in the table below, measures would affect the determination of calendar year 2014 payment rates and include seven outcome and surgical infection control measures and one healthcare associated infection measure. More measures are likely to be added in calendar year 2013.
ASC Program Measurement Set Proposed for the
Calendar Year 2014 Payment Determination (Data submission to occur in 2012 and 2013)
ASC-1: Patient Burn
ASC-2: Patient Fall
ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant
ASC-4: Hospital Transfer/Admission
ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
ASC-6: Ambulatory Surgery Patients with Appropriate Method of Hair Removal
ASC-7: Selection of Prophylactic Antibiotic First OR Second Generation Cephalosporin
ASC-8: Surgical Site Infection Rate
CMS is proposing to collect these seven measures via "quality data codes" to be placed on Part B claims submitted by ASCs for Medicare fee-for-service patients beginning January 1, 2012. The eighth reporting requirement, an outcome measure of Surgical Site Infections (SSIs), must be submitted in 2013 via the Center for Disease Control's National Healthcare Safety Network (NHSN).
CMS is proposing collecting these seven measures via "quality data codes" to be placed on Part B claims submitted by ASCs for Medicare fee-for-service patients beginning January 1, 2012. The eighth measure CMS is proposing for the ASC quality calendar year 2014 payment determination is an outcome measure of Surgical Site Infection (SSI) to be submitted in 2013 via the Center for Disease Control's National Healthcare Safety Network (NHSN).
CMS is also proposing to add two structural measures (safe surgical checklist use and ASC facility volume data on selected ASC surgical procedures) for determining the calendar year 2015 payment rates and one measure on influenza vaccination coverage among healthcare personnel for the calendar year 2016 payment rates.
C. Considerations in Selecting Quality Measures
The set of measures initial proposed by CMS addresses outcomes and infection control processes. Six of the eight initial measures are recommended by the ASC Quality Collaborative (ASC QC) and endorsed by the National Quality Forum (NQF). The seventh measure is "appropriate for measuring ambulatory surgical care, is NQF-endorsed, is currently in use in the Physician Quality Reporting System, and is similar to a measure that is being utilized in the Hospital Outpatient Quality Reporting program, and therefore aligns across settings in which outpatient surgery is performed."
In selecting the proposed quality measures, CMS focused on indicators that have a high impact on and support HHS and CMS priorities for improved health care outcomes, quality, safety, efficiency and satisfaction for patients. In general, CMS' stated goal is to adopt harmonized measures that assess the quality of care given across settings and providers/suppliers and to use the same measure specifications based on clinical evidence and guidelines for the care being assessed regardless of provider/supplier type or setting. CMS further believes that similar standards and guidelines can be applied between hospital outpatient departments and ASCs with respect to surgical care improvement because many surgical procedures are provided in both settings.
CMS will accept comments on the proposed rule until August 31, 2011, and will respond to comments in a final rule to be issued by November 1, 2011.
Judd Harwood is an associate in Balch & Bingham, LLP's Health Care Law Practice Group.