Medicare will require demonstration of QA/PI
Medicare will require demonstration of QA/PI
Under an upcoming proposal from the Health Care Financing Administration (HCFA), surgery centers that so far have bypassed accreditation can expect to be hit with a new requirement: demonstration of quality assessment (QA) and performance improvement (PI) at their centers.
This proposal is expected to be part of HCFA's shift to a more patient-centered, outcome-oriented approach to Medicare surveys. Ambulatory surgery center (ASC) managers say they support this move that will demonstrate the quality of ASCs.
"It's not fair for an office-based ENT or plastic surgeon to have the opportunity to do and perform cases in office settings without supplying quality improvement or performance improvement data to the accrediting body or Medicare people, but still require it of hospitals and ASCs," says Steven Gunderson, DO, administrator and medical director at Rockford (IL) Ambulatory Surgery Center. "It's another place where the playing field has to be leveled off."
The new emphasis on patient-centered outcomes could give ASCs a great deal more flexibility, suggests Michael A. Romansky, JD, partner in health law practice of Washington, DC, office of McDermott, Will, and Emery. Currently, many ASCs managers say they feel "micro-managed" when it comes to Medicare surveys.
"When they come in to do a survey, they look at specific things. For example, they look at charts to make sure 'I's are dotted and T's are crossed,'" says Nancy Kessler, RN, MS, executive director at El Camino Surgery Center in Mountain View, CA.
Under a new system, ASCs would demonstrate that patient outcomes are positive by demonstrating, for example, that infection rates are low and the medical record system allows for care across a continuum.
Is this feasible?
Despite the optimism, reimbursement experts express some apprehension. One concern is centered on Medicare's contracts with state health departments to conduct surveys.
"There are real questions about whether these bureaucrats are capable of mustering the imagination and creativity and flexibility to allow facilities to exercise this newfound freedom," Romansky says.
Another problem is that the same-day surgery industry hasn't made much progress in defining outcomes, Kessler says.
"What constitutes quality? When have you heard a definite answer to that?" Kessler says. "It's [HCFA's] challenge and ours." *
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