By the time this issue of Becker’s ASC Review hits your mailbox, the new Medicare ASCHOPD payment system will have been finalized (well, at least theoretically). In addition to the whole set of issues that brings up (see “Spotlight On: Coding, Billing and the New Medicare Payment System”), there are also new proposed Medicare conditions of coverage for ASCs (see “CMS Issues New Conditions for Coverage for Ambulatory Surgical Centers”). Physician-owned hospitals were required to begin disclosure of physician ownership on Oct. 1, and the industry narrowly avoided a fight with Congress over ownership (reported on p. 2 in the Sept./Oct. issue of ASC Review).
Suffice it to say 2007 has been on the busy side for the ASC and surgical hospital industries. What will 2008 do for an encore? I talked to Kathy Bryant, JD, and Craig Jeffries, Esq., about the ASC industry – including the merger of their respective groups, FASA and AAASC, into the Ambulatory Surgery Centers Association – and to Molly Sandvig, JD, the president of Physician Hospitals of America, about what lies ahead for physician-owned and surgical hospitals. “The more effective presence in Washington will increase in importance after the presidential election, when Congress and the White House look at objectives.”
The nation’s two largest ASC associations announced in October that they are merging, the culmination of five months of discussions between AAASC, FASA and the Foundation for Ambulatory Surgery in America (known as the Foundation). Beginning Jan. 1, the unified organization will be known as the ASC Association – on the same day Medicare begins to implement the biggest change in its ASC payment system in the last 20 years.
“Both [AAASC and FASA] have very strong programs,” says Mr. Jeffries. “Over the next year, we’ll see where the strengths are best blended to bring additional value to the combined memberships.”
The educational and research arms will also be combined under the Ambulatory Surgery Foundation.
What was originally AAASC’s own meeting will be cancelled, and the Foundation will conduct a meeting in San Antonio, May 14 through 17; it will serve as the annual meeting for the ASC Association.
Ms. Bryant delineated the ASC Association’s three top priorities for 2008:
• to provide ASCs with the advocacy they deserve at the federal and state levels in both the legislative and regulatory arenas, [including] continuing advocacy support for reasonable reimbursement rates and appropriate quality measures and opposition to restrictions on ASCs’ ability to provide high-quality, cost-efficient care;
• ensuring that changes to the Medicare conditions for coverage do not impede or add unnecessary burdens to ASCs; and
• assisting ASCs in meeting the day-to-day challenges of operating, [such as] helping to manage changes in reporting requirements, dealing with insurance restrictions and providing information about ASCs, including all the services they offer and the many ways they benefit their communities.
“The state associations will benefit, and the more effective presence in Washington will increase in importance after the presidential election, when Congress and the White House look at healthcare priorities,” says Mr. Jeffries. “Yes, the payment area is much more stable and we have a clearer path than we have in years past, but I would not characterize our efforts as being totally satisfied – the GI situation is still critical.”
AAASC and FASA clinical benchmarking efforts will be combined to better define quality and quantify outcomes. These activities and, most importantly, dissemination of that information will be necessary to demonstrate that 65 percent of HOPD rates doesn’t mean 65 percent of HOPD care.
“A major impediment to ASCs is that, so often, policy makers and the public lack a good understanding of exactly what ASCs are and do,” says Ms. Bryant. “To the extent that the ASCA can inform the public about what really happens in ASCs, like the topnotch surgical care they provide and the off-the-charts patient satisfaction levels they consistently report, along with the cost savings they offer, we will.
“ASCs are also reporting growing problems with insurers who refuse to contract with ASCs. We’ll definitely be looking into these problems.”
ASC participation will be a determining factor in how successful the ASC Association is in carrying out its missions.
“If we’re at about 40 percent of the industry, we’d like to double that, get up to 70 to 80 percent, more in line with the AHA’s participation,” says Mr. Jeffries. “Many physicians are currently active through specialty society involvement, and they are supporting the direction we’re going as an industry. Many of our member centers are physician-owned, and as it’s clear physician-ownership is on the federal radar screen, the ASC leadership can help [physician-owners] with the issue that concerns them most.”
“At its heart, our industry is simply not just about financial incentives. Physicans start hospitals because they see a need in the community for a more patient-centered, physician-friendly facility.”
Ms. Sandvig is certain that, in the next couple months, the physician hospital industry will be challenged again legislatively in a Medicare package bill that will include language similar to the summer’s CHAMP Act in that it will contain anti-physicianownership language.
“Primarily, we have political challenges to deal with, that’s our main issue — and it has been for quite some time,” says Ms. Sandvig. “[The legislation] is basically the symptom of a larger problem: hospital-physician relations. And right now, the way some systems are being run, hospital administration is really in opposition to physicians and their needs. So physicians are doing their own things and competing.
“What’s been interesting to me is the studies have all indicated that hospitals actually thrive when there are phys-owned hospitals in the same area. Communities become healthcare centers of excellence. Instead of viewing the competition as an incentive, hospitals view it as an aggravator.”
As a result of the political nature of the problem, physicians have to become more involved, she says: fundraising to provide money to the PHA’s PAC and to elected officials; visiting Capitol Hill personally and relaying their stories to elected officials; and undertaking grassroots education efforts such as writing letters, sending e-mails and making phone calls, are all things physicians can do “to ensure officials know who we are and what we’re doing.”
As with ASCs, another top issue is quality and getting the word out about the quality of work performed at physician-owned hospitals.
“Across the country, there’s a drive toward quality, which differs depending on whom you’re talking to,” says Ms. Sandvig. “What we’re interested in is supporting national efforts – groups such as the AMA and think tanks such as the Brookings Institute – in defining quality and how to measure it. Our definition includes patient safety and satisfaction and physician satisfaction; we want to put together our numbers [with other national efforts’ numbers] so we can display and relate those numbers to Congress and our local communities.”
PHA’s third priority for 2008 is community stewardship – “stressing within our industry the need to be community participants,” she says. “A lot of our hospitals do charitable work; although our industry is for-profit, they have the interests of the community in mind. We need to make sure those efforts are not only recognized, but that they become the standard of excellence for the physician-hospital industry.”
