CMS Proposes Revised ASC Conditions of Participation

Becker's ASC Review

Monday, August 27, 2007 Issue

The Centers for Medicare and Medicaid Services issued a proposed rule late Friday that would update the existing conditions of coverage that ASCs must meet in order to bill for Medicare services. Available online here, the new requirements will "reflect contemporary standards of practice in the ASC community, as well as recommendations from the HHS Inspector General ... [and] promote and protect patient access to quality services in ASCs," says CMS.

The agency says that the updated ASC procedure list and the pursuant changes in procedure mix in ASCs and office-based facilities are large parts of the impetus for the move.

"AAASC is delighted that CMS has proposed improvements in the Medicare Conditions for Coverage that reflect standards of practice that most ambulatory surgery centers already address," says Craig Jeffries, Esq., the executive director of AAASC. "Establishing these new requirements in regulatory rules should eliminate many of the ... oversight concerns raised by those who opposed further expansion of the list of procedures that Medicare allows to be performed in an ASC."

The proposed new conditions of participation include the following, according to CMS:

• creating a more comprehensive quality assessment and performance improvement condition (QAPI) that enables ASCs to take tailored proactive steps to ensure quality care;
  
• requiring the ASC's governing body to be responsible for the oversight and accountability for the updated QAPI program;
  
• adding a disaster-preparedness plan standard to address emergency preparedness within the facility and interaction with local and state officials;
  
• adding requirements for radiologic services provided in an ASC to ensure they are parallel to the requirements for furnishing laboratory services;
  
• adding a new patient rights condition to address disclosure of physician financial interests in the ASC, advance directives, the grievance process and confidentiality of clinical records;
  
• expanding the infection control requirement to the condition level; and
  
• adding a comprehensive patient assessment requirement to ensure that accurate and thorough assessments are conducted to assure appropriate and safe surgery, and that patients would be able to tolerate a scheduled surgical procedure.

On the whole, "these standards of practice together with the outstanding experience of ASC measured by core outcomes that will begin to be collected by CMS in 2009 address the quality elements that underscore the value of ASC for Medicare beneficiaries looking for expanded access to high quality, lower cost and patient centered procedures," says Mr. Jeffries.

However, the proposed rule still leaves some things to be desired, particularly when it comes to what CMS did not update.

"FASA is studying the proposed changes to determine the practical effect on ASCs. Although our analysis is just beginning, we are concerned that CMS may have added requirements to ASCs that will not improve outcomes or patient safety," says Kathy Bryant, JD, the executive director of FASA. "Moreover, we are disappointed that CMS has not chosen to take advantage of this opportunity to eliminate meaningless standards such as that ASCs must have a separate waiting room. FASA has commented on the proposed revisions twice and looks forward to commenting on this proposed rule."

Public comments will be accepted until Oct. 30; a final rule will be issued later this year.