American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Patient Safety and Delivery System

Ambulatory Surgery Centers

2014 Efforts

Earlier this year, the American College of Surgeons (ACS) sent letters of support for the Ambulatory Surgery Center (ASC) Quality and Access Act (H.R. 2500/S. 1137), which would transition reimbursement for ASCs to the hospital market basket update from the Consumer Price Index for All Urban Consumers. This act would also create value-based purchasing for ASCs, establish an ASC voice on the Advisory Panel on Hospital Outpatient Payment, and require the Centers for Medicare & Medicaid Services to disclose criteria used to deny procedures from being performed in ASCs.

2013 Efforts

On July 22, 2013, the ACS sent a letter of support for the Ambulatory Surgery Center (ASC) Quality and Access Act that would transition reimbursement for ASCs to the hospital market basket update from the Consumer Price Index for All Urban Consumers. This Act would also create value-based purchasing for ASCs, establish an ASC voice on the Advisory Panel on Hospital Outpatient Payment, and require the Centers for Medicare & Medicaid Services (CMS) to disclose criteria used to deny procedures from being performed in ASCs.

View the House and Senate letters of support.

Chronic Care for Medicare Beneficiaries

Sens. Ron Wyden (D-OR) and Johnny Isakson (R-GA) and Reps. Erik Paulsen (R-MN) and Peter Welch (D-VT) introduced bipartisan, bicameral legislation aimed at providing better care at lower cost for the millions of Medicare beneficiaries with multiple chronic conditions on January 15. S.1932/HR 3890 seeks to improve care coordination for those beneficiaries, which are the most expensive and fastest-growing portion of the Medicare population, and expand the use of multidisciplinary health teams to keep patients as healthy as possible in their homes and communities. The measure removes barriers preventing Medicare providers from focusing on the chronically ill and helps ensure seniors have access to specialized, patient-centered chronic care no matter where they live. The legislation helps providers by building on existing successful delivery models, and providing a framework for encouraging innovative chronic care delivery across the country. The bills have been referred to the Senate Finance Committee and the House Energy & Commerce and Ways & Means Committees, respectively.

Critical Access Hospital Relief Act (The 96-Hour Rule)

Centers for Medicare & Medicaid Services (CMS) recently indicated it would begin enforcing a long-forgotten regulation requiring that physicians admitting patients to critical access hospitals (CAHs) certify that each patient can reasonably be expected to be discharged or transferred within 96 hours. Previously, CAHs had been operating under a similar but separate condition of participation that required patient stays to be less than 96 hours on average. The recent action by CMS will result in surgeons no longer being able to admit patients for procedures routinely performed in CAHs, and patients being forced to go further from home for treatment. To address the issue, Rep. Adrian Smith (R-NE) and Sens. Pat Roberts (R-KS) and Jon Tester (D-MT) have introduced legislation to eliminate the certification requirement for admitting physicians while maintaining the long enforced 96-hour average stay requirement. The bill, known as the Critical Access Hospital Relief Act (H.R. 3991/S.2037), has been endorsed by the College.

An unofficial Congressional Budget Office score of $1.3 billion has made it unlikely that the bill will pass prior to the elections. ACS will continue working with the bills’ sponsors to build support and seek opportunities to attach the legislation to the sustainable growth rate (SGR) formula reform bill, should it come up during the lame duck session.

Download our 96-Hour Rule Fact Sheet

The American College of Surgeons (ACS) supports the Critical Access Hospital Relief Act, H.R. 3991 and S. 2037 legislation that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals. View House and Senate letters.

Contact: Matt Coffron