• FEDERAL/MEDICARE LEGISLATION AND REGULATORY ISSUES
• NEW TEXAS ASC WORKER'S COMPENSATION FEE GUIDELINES
• LICENSING
• DATA COLLECTION
• RED FLAG RULES AND ASCs
• MANAGED CARE INSURANCE
As an industry grows, its public policy needs often follow suit and increase. The Texas ASC industry is not an exception to this idea. In 2008 alone, the Texas ASC industry faced a number of important issues at the regulatory level in Austin. TASCS served as the industry’s stakeholder voice and Texas ASCs gain some of the best workers’ compensation rates for ASCs in the nation, worked with regulators to ensure that the state’s new ASC licensing rules would not add any burdensome and unnecessary rules, and advised state regulators as to how to make the new data collection procedures as efficient as possible.
TASCS continued its commitment to providing Texas ASCs with a united voice in the 2009 Texas Legislature. The TASCS Legislative Committee and membership provided the industry with a critical voice on issues regarding managed care insurance, physician ownership, workers’ compensation, data collection, and licensing issues.
TASCS will continue to be active in the Texas Legislature’s 2009-2010 interim period by serving as the industry’s stakeholder voice in the Texas regulatory arena.
TASCS Legislative/Regulatory Priorities:
Physician Ownership
TASCS strongly believes in a physician’s right to own facilities, technology and equipment used in the delivery of health care. Physician ownership Texas patients’ enhances quality of care and access to care.
TASCS supports physician ownership in all forms: ASCs, all facilities, imaging, technology, equipment and ancillary services, and advocates against any attempts to ban or restrict physician ownership in Texas, in any manner.
Managed Care
Many physician-owned facilities successfully negotiate in-network rates. However, health plans often use their superior bargaining position to try to force ASCs to agree to unacceptably low rates. As a result, many ASCs are forced to remain out-of-network, non-contracted and must bill their patients accordingly. The health plan plans then seek legislation to ban or restrict “balance billing” their patients.
TASCS opposes any legislation to limit or prohibit a non-contracted facility’s right to bill and collect from the patient and the health plan for services rendered. TASCS supports requiring health plans to provide real-time adjudication of coverage, network status of facility and physician, covered amount and the patient’s responsibility.
Workers’ Compensation
The workers’ compensation fee guidelines create two different payment rates for the same procedure. Hospital outpatient department (HOPD) fees are higher than ASC fees for the exact same procedure. Parity of fees between HOPDs and ASCs will benefit the injured workers, the employers and the workers’ compensation system (“same procedure, same fee”). In addition, our workers’ compensation laws require some adherence to CMS payment methodologies that actually prevent our workers’ compensation system from doing what’s right for the injured worker and their employers.
TASCS supports legislation establishing parity of fees between HOPDs and ASCs, and supports legislation to remove the statutory requirement that workers’ compensation fee guidelines be limited by CMS payment methodologies.
Ambulatory Surgery Reporting Requirements
TASCS strongly believes in patient safety and quality of care in both ASCs and HOPDs. In order to ensure fairness, any reporting requirements on patient safety and quality of care should be applied to both ASCs and HOPDs (“same procedure, same standard, same reporting requirement”).
TASCS supports reporting requirements for the purpose of improving safety and quality of care for all ambulatory procedures performed in ASCs and HOPDs.
RESEARCH
As the ASC industry’s state trade association, TASCS coordinates studies that provide valuable research about ASCs to the industry, public policymakers and the general public.
Texas Economic Impact Study
TASCS unveiled its first-ever Texas economic impact study at the February 2-3, 2009 State of the State Conference in Austin. The January 29, 2009 study conducted by the Health Economics Group, LLC found that Texas ASCs will have an estimated statewide impact of nearly $1.7 billion in 2009, employ approximately 7,380 Texans and pay an estimated $424 million in taxes in 2009.
To view the study, click here.
To view the TASCS summary, click here.
FEDERAL/MEDICARE LEGISLATION & REGULATORY ISSUES
The ASC Access Act of 2009 (H.R. 2049) would resolve the increasing discrepancy between ASC and hospital outpatient department (HOPD) payments, require comparable quality reporting standards for ASCs and HOPDs and assure patient access to same-day services at an ASC by allowing ASCs the opportunity to give patients notifications, required by Medicare, on the day of the procedure if it is not feasible to provide notifications further in advance.
Texas ASCs are encouraged to reach out to their members of Congress to encourage them to co-sponsor H.R. 2049. Sample letters can be accessed by visiting the ASC Association’s Web site at: http://ascassociation.org/letters/.
ASC ACCESS ACT MAINTAINS PATIENT ACCESS
As recently as six years ago, ASCs were paid 86.5 percent of hospital outpatient departments (HOPDs), on average. But a multiple year payment freeze and additional cuts have reduced ASC payment to 59 percent in 2009 of HOPD for the identical procedures.
Discretionary actions by CMS threaten to lower ASC payments to just 52 percent within the next five years, making many procedures unviable at an ASC and forcing patients to delay necessary outpatient surgery and pay substantially more in the hospital setting. Specifically, CMS is pursuing two actions, not required by statute, which threaten patient access to ASCs:
• CMS is adopting a “secondary rescaling” calculation, which reduces ASC payments when volume increases at ASCs, notwithstanding these procedures are paid at a substantial discount from hospitals where they would otherwise be performed.
• CMS proposes updating ASC payments by CPI, which represents economy-wide inflation, not market basket, which every other provider in Medicare receives and is based on their input costs.
The ASC Access Act would stop projected payment cuts by fixing ASC payments at the current 59 percent of HOPD. ASCs face inflationary pressures similar to those confronted by hospitals. Intense competition for nurses, rapidly rising medical device costs, and a growing need to adapt new health information technology contribute to inflation across a variety of health care settings. There is no policy basis for providing increasingly divergent payment rates from the already discounted payments to ASCs.
The bill requires MedPAC to conduct a study to evaluate how to encourage more clinically appropriate outpatient surgical services to be provided at the most cost-effective site of care. The bill also clarifies that ASCs may provide surgery to patients on the same day it is scheduled.
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NEW TEXAS ASC WORKER'S COMPENSATION FEE GUIDELINES: Effective September 1,2008
"Texas patients will greatly benefit from the new Texas workers' compensation ASC fee schedule. The new fee schedule represents how the [TDI-DWC] did an incredible job of listening to the ASC industry and taking into account what is required to deliver the best services possible to patients.” – TASCS President Joe Zasa, August 15, 2008
Resources:
Rate Calculator – Courtesy of Jamie Pearlman, Foundation Surgery Affiliates
White Paper – TASCS analysis of the new fee guidelines
TASCS Response to Proposal – TASCS’s July 10, 2008 letter
Workers' Compensation
TASCS played a critical role in working with the Texas Department of Insurance-Division of Workers’ Compensation (TDI-DWC) in developing some of the nation’s best workers’ compensation reimbursement guidelines for ASCs. As a result, Texas patients now have much greater access to medical care for their workers’ compensation needs.
Moving forward, TASCS is continuing to work with TDI-DWC to make sure that the implementation of the new fee guidelines is smooth and examine ways to strengthen workers’ compensation for ASC patients. TASCS worked with lawmakers to introduce legislation in the 2009 Legislature that would tie ASC workers’ compensation fee guidelines to Medicare’s hospital outpatient department (HOPD) rates.
Legislation
SB 1985 (2009 Texas Legislature) – If enacted, the bill would the Texas Department of Insurance (TDI) commissioner to adopt fee guidelines for workers’ compensation in the ASC setting to be the same fee that is paid for the same procedure performed in a hospital outpatient department or other outpatient setting.
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LICENSING
In 2008, Texas held its four-year review of ASC licensing rules. TASCS’s Licensing Ad Hoc Committee served as the industry’s stakeholder voice in the discussions that led to the new licensing rules. As a result of the hard work of committee members Mark Quigley (chair), Susan Olis, Marilyn Christian, Richard Bays and Les Hill, the Texas Department of State Health Services (DSHS) listened carefully to the Texas ASC industry’s ideas for continuing to deliver the highest quality and safest care possible to Texans.
TASCS’s working with the state led to Texas ASCs keeping accreditation as an option instead of having it serve as a mandate. Texas regulators recognized that the state’s strict standards for patient safety and quality already lead to the highest safety possible for patients in the ASC setting. In addition, mandatory accreditation would simply lead to much higher costs for patients.
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DATA COLLECTION
TASCS worked with lawmakers and regulators to make sure that Texas ASCs were not saddled with unnecessary reporting requirements that could hinder patient care in the 2009 Texas Legislature. As a result of working with TASCS, state bodies, such as the Texas Cancer Registry, determined that the best way to access information was to tap into existing data instead of requiring new reporting.
TASCS will continue serving as a stakeholder at the regulatory table when more discussions regarding data collection in the upcoming months.
Summer 2009
Click here to view an FAQ produced by TASCS.
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RED FLAG RULES AND ASCs
Beginning on November 1, 2009 , the Federal Trade Commission will enforce the Red Flag regulations. Developed to combat identity theft, ASCs were required to develop a Red Flag program to detect, prevent and mitigate identity theft as a result of falling under the FTC's definition of "creditor."
Marilyn Christian of Advantage Surgical Partners provided TASCS with an excellent example of how one Texas ASC is handling the Red Flag regulations.
Click here, to view a sample of a Identity Theft Prevention Program.
Click here, to view a PowerPoint presentation on Identity Theft Prevention.
Jason Lavender of ID Theft Solutions of America is offering a free assessment and on-site employee training to TASCS members. He can be reached at 512.514.6598.
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MANAGED CARE INSURANCE
TASCS works with Texas ASCs on both in-network and out-of-network managed care insurance issues.
Texas Department of Insurance Network Adequacy Rules
In May 2010, the Texas Department of Insurance (TDI) held its first stakeholder meeting regarding a proposed draft of commercial insurance network adequacy rules. Expected to be some of the most ambitious network adequacy rules in the nation, TASCS is serving as the Texas ASC industry's stakeholder voice throughout this process.
To view a copy of TASCS's initial stakeholder comments, click here.
To view a copy of the draft proposal, click here.