Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Updates to the ASC Quality Payment Program for 2017 and Beyond

Participating in Medicare’s Ambulatory Surgical Centers Quality Reporting Program will be strangely familiar for ASCs in 2017, as the program’s requirements to avoid a reduction of 2.0 percentage points in their annual payment update remain virtually unchanged from the previous year.

With a combination of claims-based and web-based measures, the reporting periods affecting a single payment year often cross over two calendar years.

For instance, claims-based measures ASC-1 through ASC-5 reported for 2016 dates of service were primarily submitted in 2016 and impact the 2018 payments. Web-based measures ASC-6 through ASC-11, which reference activity for 2016 dates of service, along with administrative claims-based measure ASC-12, which covers activity for 2017 dates of service, will be reported in 2017 and will impact the 2018 payments. A chart of which measures are reported and affect which year is listed below.

Payment Year 2018

Measure Reporting Method Data Collection Period Reporting Period
ASC-1 Claims 2016 1/1/16-4/30/17
ASC-2 Claims 2016 1/1/16-4/30/17
ASC-3 Claims 2016 1/1/16-4/30/17
ASC-4 Claims 2016 1/1/16-4/30/17
ASC-5 Claims 2016 1/1/16-4/30/17
ASC-6 Web-Based 2016 1/1/17-8/15/17
ASC-7 Web-Based 2016 1/1/17-8/15/17
ASC-8 Web-Based 10/1/16-3/31/17 10/1/16-5/15/17
ASC-9 Web-Based 2016 1/1/17-8/15/17
ASC-10 Web-Based 2016 1/1/17-8/15/17
ASC-11 Web-Based (voluntary) 2016 1/1/17-8/15/17
ASC-12 Administrative Claims (no data to report) 2017 2017

Payment Year 2019

Measure Reporting Method Data Collection Period Reporting Period
ASC-1 Claims 2017 1/1/17-4/30/18
ASC-2 Claims 2017 1/1/17-4/30/18
ASC-3 Claims 2017 1/1/17-4/30/18
ASC-4 Claims 2017 1/1/17-4/30/18
ASC-5 Claims 2017 1/1/17-4/30/18
ASC-6 Web-Based 2017 1/1/18-8/15/18
ASC-7 Web-Based 2017 1/1/18-8/15/18
ASC-8 Web-Based (CDC’s National Healthcare Safety Network) 10/1/17-3/31/18 10/1/17-5/15/18
ASC-9 Web-Based 2017 1/1/18-8/15/18
ASC-10 Web-Based 2017 1/1/18-8/15/18
ASC-11 Web-Based (voluntary) 2017 1/1/18-8/15/18
ASC-12 Administrative Claims (no data to report) 2018 2018

As in the past, data for claims-based measures are captured from Medicare Part B fee-for-service claims submitted for Medicare Part B FFS patients, including those enrolled in Medicare Railroad Retirement Board and Medicare Secondary plans. Medicare Advantage patients are not included for reporting purposes.

Also, ASCs with fewer than 240 Medicare primary and secondary claims per year are not required to participate. The claims threshold is recalculated each year and affects the following encounter period. For instance, an ASC with fewer than 240 Medicare claims for 2016 dates of service would not be required to participate in the ASCQR Program in data collection year 2017 for the 2019 payment determination.

Finally, in the recent 2017 Hospital Outpatient Prospective Payment System and ASC Payment System final rule, CMS added seven measures to the ASCQR program measure set for the 2018 data collection period (for 2020 payment determination) and subsequent years. The seven new measures are:

  • ASC-13: Normothermia Outcome, which assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU).
  • ASC-14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have an unplanned anterior vitrectomy (removal of the vitreous present in the anterior chamber of the eye).
  • ASC-15(a-e): Five measures that are collected using the Outpatient and Ambulatory Surgical Center Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey, a patient experience of care survey which assesses patients’ access to care, interactions with facility staff, and overall experience at the facility.

For more information about the ASCQR Program and reporting deadlines, visit the Quality Net’s Ambulatory Surgical Center Quality Reporting Program Overview webpage and consider downloading the latest specification manual.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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