Email Alert
April 25, 2011
By Webb Millsaps*
The U.S. Department of Health and Human Services Secretary (Secretary) delivered a report to Congress for how a value-based purchasing program (VBP) may be implemented for Ambulatory Surgical Centers (ASCs). The Affordable Care Act (ACA) mandated that the Secretary develop a plan for how VBP would be applied to ASCs and to submit the report to congress by January 1, 2011, but the delivery was delayed until earlier this month, April 18, 2011.
Although the report sets out a "roadmap" for possible implementation of an ASC VBP program, the Secretary does not have the regulatory authority to implement such a program without new legislation enacted by Congress. The Secretary already has the authority under the Medicare Improvements and Extension Act of 2006 and the Tax Relief and Health Care Act of 2006 (MIEA-TRHCA) to implement a quality reporting system for ASCs in a manner so as to provide for a reduction in any annual update for failure to report on quality measures. But, that authority limits the Secretary to reducing the annual update for failure to report quality data—not based on the quality of ASC performance.
The Centers for Medicare & Medicaid Services (CMS) oversees three Quality Data Reporting Programs (QDRPs) in other payment systems to promote a high value-driven healthcare system. The report emphasizes CMS' belief that promoting high-quality care in the ASC setting is highly desirable. According to the report, ASCs have rapidly become "a critical component of the United States healthcare system" and are the fastest growing type of hospital and/or physician-owned facility that participates in Medicare. During 2008 for example, more than three million Medicare beneficiaries received surgical procedures in ASCs. However, CMS states that an increasing incidence of healthcare-associated infections (HAIs) in ASCs signals the need to expand industry oversight in order to improve the quality of care.
ACA states that the Secretary must consider the following issues in developing the ASC VBP implementation plan:
-
The ongoing development, selection, and modification process for measures, to the extent feasible and practicable, of all dimensions of quality and efficiency in ASCs;
-
The reporting, collection, and validation of quality data;
-
The structure of value-based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for value-based bonus payments;
-
Methods for public disclosure of information on the performance of ASCs; and
-
Any other issues determined appropriate by the Secretary.
In preparing a plan to implement ASC VBP, the report states that CMS will consider the challenges and length of time involved with respect to developing new measures, soliciting multi-stakeholder input, seeking consensus endorsement, releasing a proposed and final rule, and accounting for differences in payment system maturity and statutory authorities across Medicare settings. In addition, the report acknowledges that CMS must give further consideration for when, as a practical matter, quality data could begin to be collected and displayed to the public, the proposed performance period for VBP, and when value-based payments could begin. Accordingly, an incremental approach for ASC VBP program implementation may be the desired approach to allow stakeholders time to adjust under a new VBP system for ASCs new system.
The following several steps, each of which is discussed in the report under the "Roadmap for ASC VBP Program Implementation" section, will be involved in designing and implementing a VBP program for ASCs:
-
Statutory authority;
-
Continuous quality improvement framework;
-
Appropriate data abstraction and submission methods, including electronic health records;
-
Enhanced data infrastructure and validation process;
-
Performance scoring and evaluation model; and
-
Transparency and public reporting.
*We would like to thank Webb Millsaps, Esquire (McDermott Will & Emery LLP, Miami, FL), for authoring this alert.