Since 2008, CMS has had authority to implement a quality reporting system for ASCs and reduce payments to providers who don’t meet certain standards, but in its proposed OPPS rules for 2011, released in early August, CMS again delayed implementing such as system.
Hospitals, ASCs agree national reporting is needed
The delay upset the hospital industry, which is already required to report HOPD rates to CMS. “The AHA encourages CMS to implement a quality reporting system for ASCs as soon as possible,” the AHA stated in an Aug. 26 letter to CMS. “It is a disservice to patients that they have access to surgical quality information from hospital outpatient departments, but the same level of transparency from ASCs is unavailable to them.”
The ASC industry agrees it is time for CMS to measure ASC quality, although it wants to start with voluntary reporting. In an Aug. 27 release, the Ambulatory Surgery Center Advocacy Committee stated: “ASCs support the implementation of a Medicare value-based purchasing program that begins with building a reliable, voluntary quality reporting infrastructure for ASCs and ultimately allows for the comparison of patient care data across all health care settings.”
The ASC industry has created its own voluntary reporting infrastructure. The ASC Quality Collaboration, formed by ASC organizations in 2006, now compiles data from 1,200 ASCs on six quality measures: rates of patient falls, burns, hospital transfer or admission, surgical site hair removal, appropriate antibiotic timing and situations involving wrong site, side, patient, procedure or implant. In a May report based on data from the fourth quarter of 2009, the collaboration said ASCs have low rates of medical error and few complications.
Ohio reporting system seen as a model
On the state level, the reporting system run by the Ohio Association of Ambulatory Surgery Centers is seen as a model. The Ohio association has been compiling reports from ASC for eight years, says Randy Leffler, executive director of the group.
The data are being primarily used for accreditation and benchmarking, he says. Members enter raw data quarterly and receive a report that is about 20 pages long comparing them to various benchmarks, such as ASCs in their region and ASCs with similar characteristics, including multispecialty or single specialty.
Mr. Leffler says the reporting includes quality data, such as infections and patient satisfaction, as well as financial data, such as case mix. He says the association has been adding indicators that CMS expected to require, such as timing of antibiotics.
“We still expect CMS to come up with quality measures,” Mr. Leffler says. “The industry really does want to encourage CMS to put the measures in place.”
Mr. Leffler hopes quality reporting can change public perceptions. “The more we can do to compare ASCs with other settings, the better the perceptions of the industry will be,” he says. “To the public we’re still sometimes seen as the storefront on the strip mall. We want them to know the quality that’s inside.”
Other state associations gear up
Three other large state ASC associations in Texas, Florida and California are gearing up to follow the Ohio association’s lead.
By early 2011, Texas Ambulatory Surgery Center Society wants to collect a variety of quality measures on a voluntary basis, says Executive Director Bobby Hillert. The Florida and California ASC groups have similar plans, he reports. Mr. Hillert says reporting categories in Texas will include the national ones plus a few more.
In addition to ASC accreditation and benchmarking, he says the data could improve state legislators’ and regulators’ acceptance of ASCs. “Our state lawmakers need to be exposed to the quality of ASCs,” Mr. Hillert says.
State reporting requirements
Meanwhile, states are beginning to require both hospital and ASC reporting on healthcare-associated infections. Mr. Hillert says Colorado ASCs already have this reporting requirement and Texas will begin on Jan. 1, 2011. The Texas data will be sent to the CDC’s National Healthcare Safety Network and than can be accessed by the state, he says.
According to the National Conference of State Legislatures, ASCs in Missouri and Pennsylvania are also required to report their infection rates. In early 2010, New Jersey also enacted HAI reporting for hospitals and ASCs.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
