Here are five regulatory and operational issues currently affecting the future of Arizona ASCs, according to Stuart Katz, executive director of Tucson Orthopaedic Surgery Center and an Arizona Ambulatory Surgery Center Association member.
1. Recent legislative changes might end up costing the healthcare system more money. AHCCCS, Arizona's Medicaid agency, recently implemented legislative changes to solve budget issues that "weren't necessarily based on good, sound medical judgment," according to Mr. Katz. The legislature included changes to coverage for several procedures, including operations that implant insulin pumps. "That change means people will have to go back to needles and insulin, and I don't think [AHCCCS] understands the long-term effects when patients are left to use [needles and insulin rather than implanted pumps]. They wind up in the hospital, which means the cost benefit isn't there in the long run," Mr. Katz says.
The legislature also eliminated coverage of cochlear implants, most orthotics, bone-anchored hearing aids and well visits. Mr. Katz says the good news is that the Arizona Ambulatory Surgery Center Association has a "really excellent working relationship with AHCCCS." He hopes that some of the changes, including the eliminated coverage of insulin pump implants, might be reversed in the future.
2. AASCA is working with the Arizona department of Health Services to make Arizona rules consistent with CMS. According to Mr. Katz, the AASCA is working to change an Arizona rule requiring ASCs to document the patient's history and physical on the chart the day before the procedure. "Medicare allows the H&P to be on the chart prior to admission, and Arizona says it has to be on the chart the day before, so there is an inconsistency there," he says. Unfortunately, Arizona Gov. Jan Brewer instituted a moratorium on all new rule-making by state agencies in Jan. 2009 in order to avoid costly, burdensome and unnecessary rules — a decision that prevents the Department of Health Services from changing the H&P rule.
Mr. Katz says the rule should be changed to ensure ASCs do not have to cancel surgeries unnecessarily. "[Physicians] have to assess the patient prior to surgery anyway," he says. "It's not as if it's the first time they're seeing the patient." He says the AASCA would like Gov. Brewer to temporarily lift the moratorium on rulemaking to allow the rule change.
3. ASCs are struggling due to low patient volume. According to Mr. Katz, Arizona ASCs — like many facilities across the country — are suffering from the state's unemployment. He says around 20 percent of Arizona residents use AHCCCS, and many centers are struggling because residents lack the discretionary spending necessary to undergo ASC procedures. "With unemployment as high as it is, people are worried about taking on that financial responsibility," he says. "It costs the entire system more when people wait so long to get surgery that they become inpatients."
4. Development of infection standards could potentially harm ASCs. Mr. Katz says while Arizona ASCs are currently in a good position to meet upcoming infection control standards, the real issue lies with the people responsible fore developing those standards. "If you have a bunch of bureaucrats back in Washington with no practical experience [developing the standards], some of them may be doable and some may be outrageous," he says. He says the AASCA supports the national ASC Association in working with CMS to develop regulations appropriate for ASCs. "We want to give input to make the brass ring attainable," he says. "I'm not saying [CMS] should make the standards so easy that everybody can qualify, but you need to be realistic."
He says requiring ASCs to have absolutely no infections is an unattainable standard, and one that he fears CMS could pass if the agency didn't seek input from ASCs. "Having a zero tolerance standard for infection would be ludicrous, and I don't think CMS would publish such a standard, but the idea that they could scares me," he says. "If your infection rate has to be less than one or two percent, those numbers are certainly attainable."
5. AASCA is working to grow and gain a stronger voice. As ASC state association numbers dwindle in many states across the country, ASC association heads are using different tactics to attract new members. Mr. Katz says one of the most effective ways to attract new members is to lower dues — a strategy that many ASC associations surprisingly don't attempt. "We just had our conference last Thursday and Friday, and it was the largest we've ever had," Mr. Katz says. The 2010 conference attracted 157 participants, up from around 65 in previous years. "We've made our dues structure less expensive," he says. "When we say we want everybody involved, we mean it."
He says state ASC associations can have a greater influence on state government decisions if they represent the majority of the state's ASCs. "Do I think we'll get to the point where we're as powerful as the Arizona Hospital and Healthcare Association? No. They will always have more money," he says. "But [by recruiting more members], we can bring more money to our side of the table."
He says the association has taken steps to provide quality services to its members at a lower cost. The association's annual meeting took place at a five-star rated hotel in Scottsdale, Ariz., at the end of the summer, meaning rates for renting the hospital space were much cheaper. "We charged $50 per center, so people could send as many staff members as they wanted," he says. "If you lessen dues, you'll create more members."
1. Recent legislative changes might end up costing the healthcare system more money. AHCCCS, Arizona's Medicaid agency, recently implemented legislative changes to solve budget issues that "weren't necessarily based on good, sound medical judgment," according to Mr. Katz. The legislature included changes to coverage for several procedures, including operations that implant insulin pumps. "That change means people will have to go back to needles and insulin, and I don't think [AHCCCS] understands the long-term effects when patients are left to use [needles and insulin rather than implanted pumps]. They wind up in the hospital, which means the cost benefit isn't there in the long run," Mr. Katz says.
The legislature also eliminated coverage of cochlear implants, most orthotics, bone-anchored hearing aids and well visits. Mr. Katz says the good news is that the Arizona Ambulatory Surgery Center Association has a "really excellent working relationship with AHCCCS." He hopes that some of the changes, including the eliminated coverage of insulin pump implants, might be reversed in the future.
2. AASCA is working with the Arizona department of Health Services to make Arizona rules consistent with CMS. According to Mr. Katz, the AASCA is working to change an Arizona rule requiring ASCs to document the patient's history and physical on the chart the day before the procedure. "Medicare allows the H&P to be on the chart prior to admission, and Arizona says it has to be on the chart the day before, so there is an inconsistency there," he says. Unfortunately, Arizona Gov. Jan Brewer instituted a moratorium on all new rule-making by state agencies in Jan. 2009 in order to avoid costly, burdensome and unnecessary rules — a decision that prevents the Department of Health Services from changing the H&P rule.
Mr. Katz says the rule should be changed to ensure ASCs do not have to cancel surgeries unnecessarily. "[Physicians] have to assess the patient prior to surgery anyway," he says. "It's not as if it's the first time they're seeing the patient." He says the AASCA would like Gov. Brewer to temporarily lift the moratorium on rulemaking to allow the rule change.
3. ASCs are struggling due to low patient volume. According to Mr. Katz, Arizona ASCs — like many facilities across the country — are suffering from the state's unemployment. He says around 20 percent of Arizona residents use AHCCCS, and many centers are struggling because residents lack the discretionary spending necessary to undergo ASC procedures. "With unemployment as high as it is, people are worried about taking on that financial responsibility," he says. "It costs the entire system more when people wait so long to get surgery that they become inpatients."
4. Development of infection standards could potentially harm ASCs. Mr. Katz says while Arizona ASCs are currently in a good position to meet upcoming infection control standards, the real issue lies with the people responsible fore developing those standards. "If you have a bunch of bureaucrats back in Washington with no practical experience [developing the standards], some of them may be doable and some may be outrageous," he says. He says the AASCA supports the national ASC Association in working with CMS to develop regulations appropriate for ASCs. "We want to give input to make the brass ring attainable," he says. "I'm not saying [CMS] should make the standards so easy that everybody can qualify, but you need to be realistic."
He says requiring ASCs to have absolutely no infections is an unattainable standard, and one that he fears CMS could pass if the agency didn't seek input from ASCs. "Having a zero tolerance standard for infection would be ludicrous, and I don't think CMS would publish such a standard, but the idea that they could scares me," he says. "If your infection rate has to be less than one or two percent, those numbers are certainly attainable."
5. AASCA is working to grow and gain a stronger voice. As ASC state association numbers dwindle in many states across the country, ASC association heads are using different tactics to attract new members. Mr. Katz says one of the most effective ways to attract new members is to lower dues — a strategy that many ASC associations surprisingly don't attempt. "We just had our conference last Thursday and Friday, and it was the largest we've ever had," Mr. Katz says. The 2010 conference attracted 157 participants, up from around 65 in previous years. "We've made our dues structure less expensive," he says. "When we say we want everybody involved, we mean it."
He says state ASC associations can have a greater influence on state government decisions if they represent the majority of the state's ASCs. "Do I think we'll get to the point where we're as powerful as the Arizona Hospital and Healthcare Association? No. They will always have more money," he says. "But [by recruiting more members], we can bring more money to our side of the table."
He says the association has taken steps to provide quality services to its members at a lower cost. The association's annual meeting took place at a five-star rated hotel in Scottsdale, Ariz., at the end of the summer, meaning rates for renting the hospital space were much cheaper. "We charged $50 per center, so people could send as many staff members as they wanted," he says. "If you lessen dues, you'll create more members."