The Centers for Medicare and Medicaid Services has released new guidelines for its Ambulatory Surgery Center Quality Reporting Program. The guidelines clarify that all ophthalmic ASCs must report on four claims-based measures between Oct. 1 and Dec. 31, to avoid a 2 percent reduction in their Medicare payments in 2014. The ASC program was created in the 2012 Medicare Hospital Outpatient and ASC Payment Final Rule. It is similar to existing Medicare quality programs for hospitals, long-term care facilities and physicians.

As a result of Academy advocacy efforts, ophthalmic ASCs will be required to report only on four of five claims-based measures, which are:

• ASC-1: Patient Burn*
• ASC-2: Patient Fall*
• ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant*
• ASC-4: Hospital Transfer/Admission*
• ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing

* Measures for ophthalmic ASCs

When patients do not experience any of the adverse events captured by these measures, ophthalmic ASCs will be able to report with a single g-code (G8907) rather than reporting each measure separately. CMS proposes that ASCs must report the measures correctly 50 percent of the time to avoid a reduction in their 2014 payments. CMS also proposes to establish a waiver process for ASCs that experience unforeseen circumstances that prevent them from reporting quality data, and an appeals process for ASCs that believe they have been unfairly penalized.

ASCs were required to implement a safe-surgery checklist and a mechanism to track procedure volume by Jan. 1. However, in response to issues raised by the Academy, the new guidelines indicate that ASCs using a safe-surgery checklist at any time during 2012 can answer “yes” when reporting use of the checklist to CMS.

For more information, contact Kelsey Kurth at kkurth@aaodc.org or 202.737.6662.