medicare’s quality reporting for ambulatory surgical centers
DESCRIPTION
Medicare’s Quality Reporting for Ambulatory Surgical Centers. Putting the Pieces Together Anita J. Bhatia, PhD, MPH Program Lead, ASC Quality Reporting Program Centers for Medicare and Medicaid Services September, 2012. Objectives. Present the Program Pieces Discuss the Program - PowerPoint PPT PresentationTRANSCRIPT
Medicare’s Quality Reporting for Ambulatory Surgical
Centers
Medicare’s Quality Reporting for Ambulatory Surgical
CentersPutting the Pieces Together
Anita J. Bhatia, PhD, MPHProgram Lead, ASC Quality Reporting ProgramCenters for Medicare and Medicaid Services
September, 2012
Putting the Pieces Together
Anita J. Bhatia, PhD, MPHProgram Lead, ASC Quality Reporting ProgramCenters for Medicare and Medicaid Services
September, 20121
ObjectivesObjectives
Present the Program Pieces
Discuss the Program
Connect the Program Pieces
Provide sources of information and assistance
Check on the Pieces
Present the Program Pieces
Discuss the Program
Connect the Program Pieces
Provide sources of information and assistance
Check on the Pieces
2
PiecesPieces
Program Participants Reporting Requirements Reporting Mechanisms Validation Extension, Waiver, & Reconsideration Requests Questions & Answers Online Assistance References
Program Participants Reporting Requirements Reporting Mechanisms Validation Extension, Waiver, & Reconsideration Requests Questions & Answers Online Assistance References
3
ProgramProgram
Quality measure data reporting for ASCs – promotes quality through measurement and publication
ASCs that do not meet program requirements face a 2% reduction in their Medicare annual payment update
Initial implementation: CY 2012 to affect CY 2014 payment
Pay for Reporting; No performance thresholds
Quality measure data reporting for ASCs – promotes quality through measurement and publication
ASCs that do not meet program requirements face a 2% reduction in their Medicare annual payment update
Initial implementation: CY 2012 to affect CY 2014 payment
Pay for Reporting; No performance thresholds4
Participants : ASCs Participants : ASCs
An ASC for Medicare purposes is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. The ASC must have in effect an agreement with CMS obtained in accordance with 42 CFR 416 subpart B (General Conditions and Requirements). An ASC is either independent (i.e. not a part of a provider of services or any other facility), or operated by a hospital (i.e. under the common ownership, licensure or control of a hospital). A hospital operated facility has the option of being considered by Medicare either to be an ASC or to be a provider-based department of the hospital as defined in 42 CFR 413.65
An ASC for Medicare purposes is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. The ASC must have in effect an agreement with CMS obtained in accordance with 42 CFR 416 subpart B (General Conditions and Requirements). An ASC is either independent (i.e. not a part of a provider of services or any other facility), or operated by a hospital (i.e. under the common ownership, licensure or control of a hospital). A hospital operated facility has the option of being considered by Medicare either to be an ASC or to be a provider-based department of the hospital as defined in 42 CFR 413.65 5
Program RequirementsProgram Requirements
Administrative Requirements QualityNet Account & Administrator Participation Status
Requirements Regarding Form, Manner, & Timing for Claims-based Measures ASCs are to report quality measure data to CMS
beginning with October 1, 2012 services Minimum case thresholds
Validation
Administrative Requirements QualityNet Account & Administrator Participation Status
Requirements Regarding Form, Manner, & Timing for Claims-based Measures ASCs are to report quality measure data to CMS
beginning with October 1, 2012 services Minimum case thresholds
Validation6
Administrative Requirements:Administrative Requirements:
Quality Net Account and Administrator In May 2013, ASCs can register with QualityNet https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename
=QnetPublic%2FPage%2FQnetTier1&cid=1138115987249
Recommend two (2) active Security Administrators per facility
Participation Status An ASC is considered as participating by submitting claims with
QDCs To withdraw from the ASC program, an ASC must submit on online
participation form indicating the desire to withdraw from the program
An ASC can withdraw for the program anytime up to August 31, 2013 for the CY 2014 payment determination
Quality Net Account and Administrator In May 2013, ASCs can register with QualityNet https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename
=QnetPublic%2FPage%2FQnetTier1&cid=1138115987249
Recommend two (2) active Security Administrators per facility
Participation Status An ASC is considered as participating by submitting claims with
QDCs To withdraw from the ASC program, an ASC must submit on online
participation form indicating the desire to withdraw from the program
An ASC can withdraw for the program anytime up to August 31, 2013 for the CY 2014 payment determination
7
Form, Manner, Timing Requirements for Claims-based
Measures
Form, Manner, Timing Requirements for Claims-based
Measures
ASCs are to report quality measure data to CMS beginning with October 1, 2012 services
Minimum case thresholds CY 2014 payment; finalized a 50% completeness
threshold in the FY 2013 IPPS/LTCH final rule
CY 2015 payment; proposed a 50% completeness threshold in the CY 2013 OPPS/ASC proposed rule
ASCs are to report quality measure data to CMS beginning with October 1, 2012 services
Minimum case thresholds CY 2014 payment; finalized a 50% completeness
threshold in the FY 2013 IPPS/LTCH final rule
CY 2015 payment; proposed a 50% completeness threshold in the CY 2013 OPPS/ASC proposed rule
8
Reporting MechanismsReporting Mechanisms
Claims Using Quality Data Codes− Patient Burn− Patient Fall− Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure,
Wrong Implant− Hospital Admission/Transfer− Prophylactic IV Antibiotic Timing
Web-based tool− Safe Surgery Check List Use− ASC Facility Volume Data on Selected ASC Surgical Procedures
National Health Care Safety Network Influenza Vaccination Coverage Among Health Care Workers
Claims Using Quality Data Codes− Patient Burn− Patient Fall− Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure,
Wrong Implant− Hospital Admission/Transfer− Prophylactic IV Antibiotic Timing
Web-based tool− Safe Surgery Check List Use− ASC Facility Volume Data on Selected ASC Surgical Procedures
National Health Care Safety Network Influenza Vaccination Coverage Among Health Care Workers
9
Quality Data Codes (QDC)Quality Data Codes (QDC)
Submit on the CMS-1500o These codes will populate fields 24D and 24F on the Form CMS-1500o Submitted charge field cannot be blank, a line item charge should be the
numeral “0”o If the system does not accept a “0” then a nominal amount can be
submitted, the beneficiary is not responsible to this amount
QDCs can be found in the ASC Specifications Manual https://www.qualitynet.org/dcs/ContentServer?c=Page&pagena
me=QnetPublic%2FPage%2FQnetBasic&cid=1228772323772
Only required to apply to claim forms where Medicare is the primary payer thru December 31, 2012 services
Required for services January 1, 2013 onward for claims where Medicare is the primary OR secondary payer; may submit for services beginning April 2012
Submit on the CMS-1500o These codes will populate fields 24D and 24F on the Form CMS-1500o Submitted charge field cannot be blank, a line item charge should be the
numeral “0”o If the system does not accept a “0” then a nominal amount can be
submitted, the beneficiary is not responsible to this amount
QDCs can be found in the ASC Specifications Manual https://www.qualitynet.org/dcs/ContentServer?c=Page&pagena
me=QnetPublic%2FPage%2FQnetBasic&cid=1228772323772
Only required to apply to claim forms where Medicare is the primary payer thru December 31, 2012 services
Required for services January 1, 2013 onward for claims where Medicare is the primary OR secondary payer; may submit for services beginning April 201210
MeasuresMeasures
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Measure Reporting Period Initial Payments Affected
1. Patient Burn Oct 1, 2012 thru Dec 31, 2012 CY 2014
2. Patient Fall Oct 1, 2012 thru Dec 31, 2012 CY 2014
3. Wrong Site, Side, Patient, Procedure, Implant
Oct 1, 2012 thru Dec 31, 2012 CY 2014
4. Hospital Admission/Transfer Oct 1, 2012 thru Dec 31, 2012 CY 2014
5. Prophylactic IV Antibiotic Timing Oct 1, 2012 thru Dec 31, 2012 CY 2014
6. Safe Surgery Check List Use Jul 1, 2013 thru Aug 15, 2013 (for Jan 1 to Dec 31, 2012)
CY 2015
7. Volume of Selected Procedures (all-payer)
Jul 1, 2013 thru Aug 15, 2013 (for Jan 1 to Dec 31, 2012)
CY 2015
8. Influenza Vaccination Coverage Among Health Care Workers
Oct 1, 2014 thru Mar 31, 2015 CY 2016
ValidationValidation
As stated in the FY 2013 IPPS/LTCH final rule
No requirement for validation of structural measures
No requirement for validation of the current claims-based measures
As experience gained with the program, CMS will reassess whether a data validation process is needed
As stated in the FY 2013 IPPS/LTCH final rule
No requirement for validation of structural measures
No requirement for validation of the current claims-based measures
As experience gained with the program, CMS will reassess whether a data validation process is needed 12
Extension, Waiver, & Reconsideration Requests
Extension, Waiver, & Reconsideration Requests
Extraordinary Circumstances extension and waivers are available on the QualityNet Web siteo Must submit 45 days from when the extraordinary
circumstance occurredo Must provide evidence of the circumstance incident
Reconsideration Processo For failure of meeting ASC Quality Reporting Program
Requirementso Submit a reconsideration request form available on the
QualityNeto Must be submitted by March 17th of the affected
payment year
Extraordinary Circumstances extension and waivers are available on the QualityNet Web siteo Must submit 45 days from when the extraordinary
circumstance occurredo Must provide evidence of the circumstance incident
Reconsideration Processo For failure of meeting ASC Quality Reporting Program
Requirementso Submit a reconsideration request form available on the
QualityNeto Must be submitted by March 17th of the affected
payment year 13
Questions & Answers Questions & Answers
Accessible via link on www.qualitynet.org or directly https://cms-ocsq.custhelp.com/
Found on Website on QualityNet Outpatient Questions and Answers Specific Questions and Answers related to ASCs Must sign-in and create an account with password to
ask a question https://cms-ocsq.custhelp.com/
Accessible via link on www.qualitynet.org or directly https://cms-ocsq.custhelp.com/
Found on Website on QualityNet Outpatient Questions and Answers Specific Questions and Answers related to ASCs Must sign-in and create an account with password to
ask a question https://cms-ocsq.custhelp.com/
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AssistanceAssistance
ASC Quality Reporting Web page www.qualitynet.org
ASC Quality Reporting section www.cms.hhs.gov
Listserv https://www.qualitynet.org/dcs/ContentServer?pagename=QnetPublic/ListServe/Register
Direct Support Telephone (toll-free) 1-866-800-8756, Monday-Friday 7:00
am to 6:00 pm Eastern Time Email http://[email protected]
ASC Quality Reporting Web page www.qualitynet.org
ASC Quality Reporting section www.cms.hhs.gov
Listserv https://www.qualitynet.org/dcs/ContentServer?pagename=QnetPublic/ListServe/Register
Direct Support Telephone (toll-free) 1-866-800-8756, Monday-Friday 7:00
am to 6:00 pm Eastern Time Email http://[email protected]
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Public ReportingPublic Reporting
Per statute, data collected under the ASC Quality Reporting Program is to be made publicly available
Finalized in the FY 2013 IPPS/LTCH final rule that any and all data collected could be made available
Earliest publication would be in 2014
Per statute, data collected under the ASC Quality Reporting Program is to be made publicly available
Finalized in the FY 2013 IPPS/LTCH final rule that any and all data collected could be made available
Earliest publication would be in 2014
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References: RulesReferences: Rules
CY 2012 OPPS/ASC final rule (published) http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012
-16813.pdf
FY 2013 IPPS/LTCH Final Rule Home Page (display) http://www.ofr.gov/OFRUpload/OFRData/2012-19079_PI
CY 2013 OPPS/ASC proposed rule (published) http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012
-16813.pdf
CY 2012 OPPS/ASC final rule (published) http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012
-16813.pdf
FY 2013 IPPS/LTCH Final Rule Home Page (display) http://www.ofr.gov/OFRUpload/OFRData/2012-19079_PI
CY 2013 OPPS/ASC proposed rule (published) http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012
-16813.pdf 17
Additional References Additional References
Ambulatory Surgical Centers Center
http://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html
Transmittal 2425 CY 2012 OPPS/ASC final rule HHS Report to Congress (ASC Value Based
Purchasing)
Ambulatory Surgical Centers Center
http://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html
Transmittal 2425 CY 2012 OPPS/ASC final rule HHS Report to Congress (ASC Value Based
Purchasing)
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Checking the PiecesChecking the Pieces
What can be improved? What do you like? Do you like anything? What don’t you like? What do you think?
Thank you!
What can be improved? What do you like? Do you like anything? What don’t you like? What do you think?
Thank you!