Advocacy in Austin
The primary focus of TASCS is to serve as the industry’s stakeholder voice in Austin. Industry news and opportunities for Texas ASCs to get involved can be found in our regular e-mail newsletters.
Calendar
November 10-11, 2011
TASCS Annual Conference
Lean more about the state and federal issues impacting ASCs.
Winter/Spring 2011
TASCS State of the State Conference
This annual event gives ASCs an opportunity to learn more about state rules and regulations.
Winter/Spring 2011
Washington Visit
* In September 2011, over 15 TASCS members visited Washington lawmakers. We will repeat this trip in 2011.
Commercial Insurance
The recent trend of declining commercial insurance rates has become one of the most important issues over the past few years. TASCS has been engaged in both in-network and out-of-network commercial insurance issues in Austin.
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Physician Ownership
A study by the Medicare Payment Advisory Commission (MedPAC) found that approximately 90 percent of all ASCs are physician-owned. This is due to the fact that ownership leads to an efficient and high-quality operation for patients.
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State Licensing Issues
As the industry’s stakeholder voice in Austin, TASCS provides input to policymakers when they are considering changes to the ASC licensing rule.
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Operation ASC Open House
This is our new grassroots program.
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Welcome to the TASCS Policy Page:
As the industry’s stakeholder voice in Austin, TASCS is involved in a number of public policy issues that impact the Texas ASC industry. With an experienced team of public policy experts, TASCS has played a major role in a number of issues that impact Texas ASCs.
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 the past several years, TASCS has served as the industry’s stakeholder voice in many important policy issues impacting ASCs, including commercial insurance, workers’ compensation, ASC licensing, data collection, and other health care reforms.
However, an industry’s public policy voice is only as strong as its membership. As a result, TASCS dedicates a tremendous amount of effort to educate its membership about the issues and get it engaged in the policy process.
TASCS accomplishes its policy goals through the following measures:
- Legislative Committee. Members of the ASC industry serve on the TASCS Legislative Committee to make policy recommendations.
- Learn more about the issues. TASCS’s conferences and regular e-mail newsletters help educate the membership about the issues that are impacting ASCs.
- Grassroots efforts. TASCS provides its members to make trips to Austin and Washington to talk to policymakers about the issues. For those who cannot make these trips, TASCS provides opportunities for lawmakers to visit ASCs.
If you would like to be more active in the public policy process, please check our Web site and e-mail newsletters for more details.
Advocacy in Washington
TASCS is active in Washington, DC. TASCS members visit Washington several times a year to discuss the value of ASCs in the Medicare system.
Medicare
While the new Medicare payment system recognizes a number of surgeries and procedures that can be performed in the ASC setting, the disparity between hospital outpatient (HOPD) and ASC rates is so wide that it forces a lot of surgeries out of the ASC setting. TASCS has been active at the federal level to close this gap between HOPD and ASC rates.
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Quality Issues
On January 1, 2012, ASCs are expected to begin reporting quality data to Medicare. In addition, ASCs will begin reporting healthcare-associated infection (HAI) data to the state of Texas beginning in October 2011. TASCS has played an important role at both the state and federal levels in regards to the quality issues.
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Industry Research
As the industry’s stakeholder voice, TASCS gathers research about the ASC industry.
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Workers’ Comp
Several years ago, TASCS served as the industry’s stakeholder during the state’s process for the new Workers’ Compensation rule. It resulted in rates and regulations that will ensure that patients can seek their workers’ comp care in the ASC setting. While several other states have made cuts to ASCS in the workers’ comp system to achieve savings, TASCS has worked with Texas policymakers to make sure that patients do not lose access to the ASC setting.
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Data Collection
On January 1, 2012, ASCs are expected to begin reporting quality data to Medicare. In addition, ASCs will begin reporting healthcare-associated infection (HAI) data to the state of Texas beginning in October 2011. TASCS has played an important role at both the state and federal levels in regards to the quality issues.
Learn more...
COMMERCIAL INSURANCE ↑ top
Over the past few years, the ASC industry has witnessed an increasing trend of commercial insurance plans offering lower in-network and out-of-network rates to ASCs. Perhaps most concerning, many of these rates are now being tied to Medicare, a government price setting plan.
As a result, TASCS has worked with state and federal lawmakers to educate them about how inadequate rates can harm patient access to the safe, high quality, and efficient ASC setting.
Many ASCS 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.
Key Dates
Fall 2011/Winter 2012 – Texas Department of Insurance’s rulemaking process for exclusive provider organization (EPO) benefit plans.
November 10, 2011 – FAIR Health Inc. will discuss its usual and customary database at the TASCS 2011 Annual Conference. In addition, Jared Wolfe, executive director of the Texas Association of Health Plans, will discuss commercial health insurance.
January 1, 2014 – The introduction of the state’s health insurance exchange (as required by the Affordable Care Act).
Legislation/Regulations
From the 2011 Texas Legislature:
HB 1772 – Passed and signed into law. It amended the insurance code to allow for exclusive provider organization (EPO) benefit plans.
HB 2697 – TASCS sponsored and supported HB 2697, which would have required commercial health plans to reimburse out-of-network facilities based on a usual & customary rate that is calculated by using the new FAIR Health, Inc. database. FAIR Health, Inc. was created to replace Ingenix. The measure passed out of the House Insurance Committee with only one member voting against it. TASCS will work with lawmakers on this concept in the months leading up to the 2013 Legislature. The bill is expected to be introduced again in 2013.
Research
TDI Network Adequacy – TASCS provided the ASC industry’s response to TDI’s network adequacy rule.
Usual & Customary Standards – The attached paper was shared with lawmakers during consideration of HB 2697.
PHYSICIAN OWNERSHIP ↑ top
A study by the Medicare Payment Advisory Commission (MedPAC) found that approximately 90 percent of all ASCs are physician-owned. This is due to the fact that ownership leads to an efficient and high-quality operation for patients.
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.
STATE LICENSING ISSUES ↑ top
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.
OPERATION ASC OPEN HOUSE ↑ top
Summary
Texas ASCs are transforming the state’s health care system by delivering high quality and safe surgeries and procedures in a comfortable and efficient setting. Despite the remarkable quality and efficiency that they have brought to the health care delivery system, ASCs are facing a number of public policy and industry challenges.
State representatives and senators play a central role in many of these issues. ASCS will achieve positive outcomes in public policy decisions if lawmakers have a first-hand understanding of the ASC model. The only way for that to happen is for lawmakers to visit ASCs and witness first-hand the safety and quality that they are delivering.
We are asking Texas ASC Society members to invite lawmakers to visit their ASCs in the months leading up to the 2013 Texas Legislature.
Goal
When a lawmaker makes a legislative decision regarding health care, we want them to turn to their local ASC for guidance.
Inviting a Lawmaker to your ASC
"A tour provides you with an opportunity to explain to a legislator how your ASC provides high quality surgical care in an efficient, lower cost setting, while still highlighting the challenges you face with the current level of reimbursement." - Steve Miller, ASC Association
"Folks beat money anytime in a political fight.” – Cong. Barney Frank
Inviting a lawmaker to tour your ASC is the most effective way for our industry to deliver our message. The most effective way to do this is to call your lawmaker’s district office. The person answering the phone is likely to serve as the district scheduler.
Ask him/her if you could make a schedule request for the lawmaker to visit your ASC. If you need assistance in making an invite, please contact Jaime Capelo – TASCS’s lobbyist.
Preparing for a Visit
Once a visit has been scheduled, it is time to prepare for the event. ASCs that have hosted lawmakers in the past have found the following items to be helpful:
- Background information. E-mail the lawmaker’s staff all of the information regarding the visit. This includes the agenda, the names of people who he or she may meet, and information about the ASC (number of procedures, physicians, etc.).
- Less time is more. Keep in mind that the lawmaker’s schedule is busy. A shorter visit that focuses on the key points can be the most helpful and memorable.
- Telling your story. The visit is a great opportunity share information about your facility. This includes your safety, quality, clinical outcomes, patient satisfaction, and economic data (number employees, physicians, amount of taxes paid, etc.).
- Media and other groups. Ask your lawmaker’s staff if it would be okay to publicize the event or invite somebody from the local media, the local chamber of commerce, or another medical group such as the county medical society to attend.
Sample Visit
9:00 a.m. – 9:10 a.m. Arrival and Welcome
9:10 a.m. – 9:30 a.m. Tour
9:30 a.m. – 10:00 a.m. Discussion with physicians and staff
Follow Up
Once your lawmaker leaves your facility, this does not mean the end of your relationship with him/her. In fact, this should be the beginning of a relationship with that lawmaker. In the future, please be sure to:
- Throughout the year, provide your thoughts on various health care issues to him/her.
- Attend town hall meetings.
- Send pictures of the visit to your county medical society and chamber of commerce.
ASC Message
We want to deliver several messages to lawmakers:
- ASCs deliver safe and high quality care to patients in a convenient and low cost environment.
- It is important for commercial insurance plans to recognize this.
- The government plans, such as the Teacher Retirement System and Employee Retirement System, should recognize this.
Our 2013 Legislative priorities can be found below. In addition, two sample sheets that we can give you to give to lawmakers.
FEDERAL LEGISLATION – H.R. 2108 & S. 1173↑ top
In June of 2011, US Representatives Pete Sessions (R-TX) and John Larson (D-CT) and US Senators Ron Wyden (D-OR) and Mike Crapo (R-ID) introduced the ASC Quality and Access Act of 2011 into the US Congress. These elected officials, dedicated to ensuring quality health care and saving Medicare money, introduced this bill to accomplish four important goals:
- Prevent the widening gap between ASC payments and hospital outpatient department payments for identical procedures.
- Create a value-based purchasing system for ASCs.
- Implement an appropriate reporting system to measure the high quality care that is provided in the ASC setting.
- Allow Medicare patients to receive surgery on the same day they schedule a surgical procedure.
Research
Please visit the ASC Association’s advocacy page to learn more about the legislation:
MEDICARE ↑ top
Medicare Background
ASC Medicare rates are determined by their relative weights under the outpatient prospective payment system (OPPS), which is used by Medicare to set its rates for hospital outpatient departments (HOPDs).
Unfortunately, this results in a much lower reimbursement rate for ASCs, despite being the exact same surgery. For example, for most covered surgeries for ASCs in 2010, the Medicare payment rate was the product of its relative weight and a conversion factor set at $41.87. Meanwhile, the conversion factor in the hospital OPPS for 2010 was $67.41.
However, Congress began a 6-year rate freeze under Medicare in 2004, despite the annual increases in prices for the goods and services needed to provide outpatient surgery. As a result, the relationship between ASC and Hospital Outpatient Departments (HOPDs) payments fell from 86 to 57 percent for identical services.
In 1982, Medicare created its ASC conditions for coverage. As a result, Medicare certified ASCs and paid a facility fee for specified surgeries and procedures in Medicare-certified ASCs. The conditions for coverage include minimum standards for coverage: anesthesia, quality evaluation, operating and recovery rooms, medical staff, nursing services, infection control, and other areas.
From 1982 until 2008, Medicare provided ASCs a facility payment for a limited number of surgeries and procedures. As a result of the 2003 Medicare Modernization Act (MMA), CMS was required to greatly expand the number of Medicare surgeries and procedures performed in the ASC setting. However, this also resulted in much lower reimbursement rates when compared to ASCs (when compared to hospitals).
The 2003 Medicare Modernization Act required CMS to create a new ASC reimbursement system. This was a phase in period from 2008 through 2011. Today, Medicare now covers about 3,400 surgeries and procedures in the ASC setting.
Medicare Challenges
While the new Medicare payment system recognizes a number of surgeries and procedures that can be performed in the ASC setting, the disparity between hospital outpatient (HOPD) and ASC rates is so wide that it forces a lot of surgeries out of the ASC setting.
The hospital outpatient market basket annual update, which is the annual increase provided to hospital outpatient departments, is a far more accurate measure of medical costs. Unfortunately, the ASC annual update is tied to the general inflation rate (CPI-U), which is a much lower rate. As a result, the HOPD and ASC Medicare rates are facing a widening gulf each year. On top of that, ASCs receive a productivity adjustment, which can offset the meager inflation update.
ASC Industry Efforts
TASCS and the ASC Advocacy Committee are working with Congress to make sure that surgeries are available to Medicare patients in the ASC setting.
“Compared to the HOPD setting, every procedure performed in an ASC saves the Medicare program more than 40 percent and usually saves Medicare beneficiaries between 50 and 60 percent on their co-payments. About 75 percent of the growth in ASC services is the result of patients and their physicians using ASCs instead of HOPDs. In fact, if this trend were to increase and shift half of all eligible outpatient procedures from HOPDs to ASCs, Medicare would save an additional $2.3 billion every year.” - Data gathered by the ASC Advocacy Committee, the industry’s national public policy stakeholder voice.
QUALITY ISSUES ↑ top
TASCS is working with the ASC Association and other industry stakeholders on Medicare's quality reporting proposal for 2012.
Key Dates
January 1, 2012 - Proposed starting date for Medicare's quality reporting for ASCs.
Research
CMS stakeholder comments to CMS on quality reporting, click here.
INDUSTRY RESEARCH ↑ top
As the industry’s stakeholder voice, TASCS gathers information about the ASC industry. TASCS is expecting a number of studies about the Texas ASC industry to be published in the early months of 2012.
Research
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.
Coming Soon
Workers’ Compensation Study
In early 2012, a study regarding the savings that the Texas Workers’ Comp System can generate by utilizing ASCS is expected.
Employee Retirement System & Teacher Retirement System
In early 2012, a study regarding the savings that these two state public plans can generate by utilizing ASCs is expected.
ASC Social Media Study
A study regarding the use of social media advertising and surgery is expected to be published.
WORKERS' COMPENSATION ↑ top
"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 then-President Joe Zasa, August 15, 2008
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.
Key Dates
September 27, 2011 – Deadline to comment on the state’s pre-authorization process. This is a rare opportunity to open the rules.
Legislation/Regulations
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.
Research
Rate Calculator
White Paper – TASCS analysis of the new fee guidelines
TASCS Response to Proposal – TASCS’s July 10, 2008 letter
DATA COLLECTION ↑ top
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.