Here are 11 key notes on quality report for ASCs.
1. The Ambulatory Surgical Center Quality Reporting Program is a pay-for-reporting, quality data program, under which ASCs report quality data for standardized measures to receive the full update to their annual payment rate. CMS implemented the program in 2012.
2. ASCs that fail to report the necessary quality data will be dealt pay cuts. The centers that failed to report data by the deadlines in 2012 had their payments cut by 2 percent in 2014. Those centers that failed to report in 2013 will see payment cuts this year, and so on for subsequent years. The pay cuts are not cumulative, however.
3. To avoid the pay cuts for calendar year 2016, ASCs must report the following quality measures:
• 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 Safe Surgery Checklist Use
• ASC-7 ASC Facility Volume Data on Selected ASC Surgical Procedures
• ASC-8 Influenza Vaccination Coverage among Healthcare Personnel
4. CMS will base the calendar year 2017 payment determinations on claims with dates of service from January 1, 2015 through December 31, 2015, that are received in the Medicare Claims Warehouse by April 30, 2016.
5. According to CMS' final 2015 ASC payment rule, "ASC-11: Cataracts: Improvements in Patient's Visual Function within 90 Days Following Cataract Surgery" is a voluntary measure for the ASC Quality Reporting Program.
Initially, the measure was to be implemented in 2014. However, following advocacy from the American Society of Cataract and Refractive Surgery, American Academy of Ophthalmology, Outpatient Ophthalmic Surgery Society and Ambulatory Surgery Center Association, the implementation was delayed. CMS stated that it "recognizes the operational difficulties with this specific measure." In its 2015 rule, the measure was made voluntary.
6. The final deadline, as mandated by the final rule, for ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel was May 15, 2015. Facilities had to report vaccination data for three categories of healthcare personnel — employees on payroll; licensed independent practitioners, who are physicians, advanced practice nurses and physician assistants affiliated with the facility but not on payroll; and students, trainees, and volunteers aged 18 years or older. All healthcare personnel who physically worked in the facility for at least one day or more in the flu season from Oct. 1, 2014 to March 31, 2015 had to be counted. The quality measure also had to be reported through the National Healthcare Safety Network.
7. The Physician Quality Reporting System encourages individual eligible professionals and group practices to report quality information to Medicare. Those participating in the program may submit their clinical quality measures electronically through the PQRS EHR reporting option to fulfill the CQM requirements for both PQRS and the Medicare EHR Incentive Program, which provides incentives for the adoption and meaningful use of certified EHR technology.
Participation in the Physician Quality Reporting System program increased by 47 percent from 2012 to 2013, according to CMS' 2013 Physician Quality Reporting System and Electronic Prescribing Incentive Program Experience Report. The 2013 PQRS incentive payments totaled $214 million.
8. A new piece of legislation has been introduced in the House of Representatives to provide relief for ASC physicians attesting for meaningful use. The HITECH Act of 2009 incentivized Medicare providers to adopt and use EHR systems. But ASCs were not eligible for HITECH funds to develop the systems. Under the system, as it stands at the moment, physicians had to attest to meaningful use of certified electronic health record technology in 2014 or face penalties in 2015.
The Electronic Health Fairness Act would exempt ASC patient encounters from being counted toward meaningful use of EHRs until such time as a certified electronic health record technology product exists for the ASC setting.
9. The ASC Quality Collaboration published a report on ASC quality data. The report presented aggregated performance data for ASC facility-level quality measures collected by a number of volunteer organizations.
In the first quarter of 2015, the report shows:
• Patient fall rate per 1,000 ASC admissions: 0.136
• Patient burn rate per 1,000 ASC admissions: 0.019
• Hospital transfer/admission rate per 1,000 ASC admissions: 1.110
• Rate of wrong site, side, patient, procedure, implant events: 0.030 per 1000 admissions
• Percentage of ASC admissions with antibiotics ordered who received antibiotics on time: 99 percent
• Percentage of eligible ASC patients with normothermia: 91 percent
• Percentage of ASC cataract surgery patients with unplanned anterior vitrectomy: 0.50 percent
10. Possible new quality measures may include:
• Postoperative nausea and vomiting
• Toxic anterior segment syndrome
• All case hospital admission within two days of discharge
• All case emergency department visits within two days of discharge
11. In July, CMS released its proposed policy and payment changes rule for the CY 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. It did not propose any new measures for the ASC Quality Reporting Program.