MASCA NEWSLETTER

Fall 2017

“Joining” vs. Being an Active Member of Your Organization

Factual and Legal Issues of Malpractice in Ambulatory Surgical Centers

2018 Final ASC Medicare Payment Rule Released

“Joining” vs. Being an Active Member of Your Organization

There is a vast array of opportunities for those who

join a professional association, but it takes more than

simply signing up and paying the membership fees to

actually benefit from those opportunities. Being an

active member ensures that you are taking the fullest

advantage of what is available to you, allowing you to

grow as an individual and strengthen the organization

as a whole. Go beyond just joining and instead, become

and stay an active member of your organization for

the following reasons.

Newsletter | Fall 201701

Strength in NumbersNetworking and making connections among those in your association is a critical part of meeting your professional goals. Most organizations sponsors numerous events throughout the year at local, state and national levels that allow members to connect and become resources for one another. To acquire these connections, members must not only show up, but be informed and engaged with those around them.

With the expansion of your network in your career field, you are presented with an established support system where you can ask for advice, brainstorm new ideas, and ultimately share the work load with like-minded individuals. Each member has their own strengths and weaknesses and everyone contributes a specific skill set to their organization. Working with other professionals in your association allows you to combine and utilize a diverse set of strengths and skills from your peers, while showcase your own. This leads to a well-rounded and successful outcome for yourself and your peers, and therefore the entire organization.

Professional DevelopmentYou can never be presented with too many opportunities to further yourself in your career. Being an active member in your association presents access to resources and knowledge that you might not find elsewhere. Through seminars, workshops, publications, and many other avenues, members can take advantage of the collective knowledge of their entire association. Attending your local meetings as well as the state and national conferences is perhaps the best way to grow as a professional. These gatherings allow members to discover groundbreaking ideas and exposure to key achievers amongst their industry. Staying on top of these changes and developments is important for every professional, and results in a more knowledgeable and successful member.

Simply listing membership in a professional association on a resume can be beneficial, but being an active member in your association allows you to discuss, in detail, your responsibilities within the organization, the events you attended or organized, and the specific ways that your membership has helped you progress in your profession. This is a great example to current and future employers of your dedication to your career by staying connected and informed about your career field and always taking the opportunities to continue bettering yourself in the work place.

Personal DevelopmentBeing active in your organization is not only essential for your professional growth, but for your personal growth as well. Being an active participant means working with other members, and there you can further develop a host of skills in leadership, organization, teamwork, communication, and problem solving. You might find yourself in a situation where you can mentor your peers, and you can tremendously benefit by giving back and sharing your knowledge with the group. Being surrounded by those who share similar interests as you is not only a fast way to meet new people, develop friendships, and have fun, but can also motivate you and increase your productivity.

With any association membership, whether you are a recent graduate looking for networking opportunities or a seasoned professional seeking the newest trends in your industry, you will get out of it what you put into it. Joining a professional organization is a good start, but to maximize your time and efforts as a professional who is already met with the demands it takes to be successful in your field: don’t just show up, participate!

By: Tammy Burnett, President

We all are familiar with complex medical malpractice lawsuits against hospitals that include claims against the numerous professionals and

staff members involved in the treatment of admitted patients. The list of parties and potential cross-claims against other parties can be extensive. Approximately 25 million surgical procedures, however, are performed every year at ambulatory surgical centers (ASCs), as opposed to at acute care hospitals. Given the nature of ASCs and their common business model − to treat patients safely in an economical and expeditious manner without the need for an overnight stay − there are certain theories of malpractice that predominate. The factual and legal issues that must be examined by a defense attorney when an ASC is first faced with a medical malpractice claim differ somewhat from those raised when there are other defendants that may have caused or contributed to the alleged injury. The number of parties and theories of liability may be limited but the defense must be equally vigorous.

“The number of parties and theories of liability may be limited but the defense must be equally vigorous.”

One of the more common claims against an ASC is a failure to recognize an injury prior to the patient’s discharge. For example, a patient may claim that a physician or nurse failed to appreciate the signs of a colon perforation, discharged the

patient too quickly and, as a result, the patient became septic or suffered some other physical injury. Another common claim arises from the question of whether the patient was healthy enough to undergo the procedure outside an acute care hospital setting.Whether the ASC is vicariously liable for the conduct of a surgeon or anesthesiologist is another common legal issue. A good first step in evaluating the potential for vicarious liability is to obtain the physician’s employment contract and determine whether the doctor is an employee, owner or independent contractor. However, the potential for vicarious liability often depends entirely on where a plaintiff’s lawsuit is venued. For instance, in New York, under Mduba v. Benedictine Hospital, 52 A.D.2d 450 (3rd Dept 1976), and its progeny, the ASC may be vicariously liable for a non-employee doctor under an apparent or ostensible agency theory if the surgical center gives the appearance that the physician or anesthesiologist was acting on the surgical center’s behalf. On the other hand, if the claim accrued in Virginia, you may have a very different outcome, given that Virginia does not recognize apparent agency in these situations. Sanchez v. Medicorp Health System, 618 S.E.2d 331 (Va. 2005).

In sum, even though the same factual and legal issues arise in the ASC context as we see in cases involving procedures at acute care hospitals, early recognition of the issues that are most often found in ASC claims can lead to a more efficient and effective disposition of the claim.

Fall 2017| Newsletter 02

Factual and Legal Issues of Malpractice in Ambulatory Surgical Centers

Thursday, November 2, 2017

Fall 2017| Newsletter 04

Save the Date

MASCA Day at the Capitol

Jackson, Mississippi

January 9, 2018

9:00am

Removal of Total Knee Arthroplasty (TKA) Procedure from the IPO ListCMS did finalize the removal of TKA from the inpatient-only list for 2018. CMS indicated that, regarding other joint replacement codes, they were going to allow for further discussion before finalizing their removal from the inpatient-only list.

Changes to the ASC Quality Reporting Program

There were significant changes proposed to the ASC Quality Reporting Program. Most significantly, CMS is delaying the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program for CY 2018 data collection.

CMS is also removing three measures for the CY 2019 payment determination and subsequent years: (1) ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing; (2) ASC-6: Safe Surgery Checklist Use; and (3) ASC-7: ASC Facility Volume Data on Selected Procedures.

“ASCA remains fully committed to assisting CMS in developing a robust quality reporting program that can guide patients to the appropriate site of service for the care they need,” Prentice added. “Beneficiaries deserve to know more about the cost and quality of the care they receive through the Medicare program.”

CMS did not finalize its proposal to adopt ASC-16: Toxic Anterior Segment Syndrome for the CY 2021 payment determination and subsequent years.

The Agency did, however, finalize two measures collected via claims for the CY 2022 payment determination and subsequent years (ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures; and ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures).

2018 Final ASC Medicare Payment Rule Released

The Centers for Medicare & Medicaid Services (CMS) released its 2018 final payment rule for ASCs and hospital outpatient departments (HOPDs)

recently. Both ASCs and HOPDs will receive lower increases than were proposed in July.

On average, ASC payment rates will increase by 1.2 percent in 2018. This increase is based on a projected rate of inflation of 1.7 percent minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act. This increase is lower than the 1.9 percent effective update that was included in the proposed rule.

“Yet again, ASC payments fall farther behind those of hospital outpatient departments because CMS continues to use an inflation factor—the CPI-U—that doesn’t focus on the costs of goods and services in the healthcare market,” said Bill Prentice, CEO of the Ambulatory Surgery Center Association. “CMS insists on waiting for a perfect replacement to the CPI-U while a good one, the hospital market basket, is available.”

Hospital outpatient departments (HOPDs) will receive a 1.35 percent increase, based on a 2.7 percent market basket update minus a 0.6 percent adjustment for economy-wide productivity and a 0.75 percentage point adjustment required by statute. This increase is lower than the 1.75 percent effective update that was included in the proposed rule.

Please note that these are average increases, and that updates may vary significantly by code and specialty. It is also important to note that CMS does not consider sequestration in this rule. This statutory 2 percent reduction remains in effect until at least 2024 unless Congress acts.

Three new procedures finalizedThe agency finalized the addition of three new procedures to the ASC list of payable procedures for 2018. These codes are:

• 22856 (Cerv artific diskectomy);

• 22858 (Second level cer diskectomy); and

• 58572 (Tlh uterus over 250 g)

In the proposed rule, CMS solicited comments on whether total knee arthroplasty, partial hip arthroplasty (PHA) and total hip arthroplasty (THA) meet the criteria to be added to the ASC Payable List. In this final rule, CMS made the determination that these codes should continue to be excluded from the ASC covered procedure list, stating that “because our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure.”

ASC HOPDInflation update factor 1.7% 2.7%

Productivity reduction mandated by the ACA

0.5 percentage

points

0.6 percentage

points

Additional reduction mandated by the ACA

N/A 0.75 percentage

points

Effective update 1.2% 1.35%

Conversion factor $45.575 $78.636

The information below provides a comparison between the 2018 ASC and HOPD final rule updates:

Newsletter | Fall 201703

Newsletter | Fall 201705 Fall 2017| Newsletter 06

Fall MASCA Membership Meeting

THANKS FOR COMING!Please mail completed application and payment to the MASCA at:Mississippi Ambulatory Surgery Center Association200 N. Congress St., Ste. 500, Jackson, MS 39201Or fax completed applications to (877) 936-4426

The IRS requires we inform you that membership dues may be deductible as a normal business expense, but not as a charitable contribution.

Contact Name _____________________________________________ Title __________________________________

Facility/ Company Name ___________________________________________________________________________

Address _____________________________________________________________________________________________

City ______________________________ State _______________________ Zip __________________________________

Phone _____________________ Fax _______________________ Email _____________________________________

Alternate Contact Name ___________________________________Title ___________________________________

Phone _____________________ Fax _______________________ Email _____________________________________

Visa MC Card #: ______________________________ Exp: _______________Security: __________________

Name of Cardholder: ________________________________________________________________________________

Authorized Signature: ___________________________________________________Date: ______________________

Billing Address for Card (if different from above): __________________________________________________

State License Number_____________________________

Facility Information

Accreditation

Payment Information

Independent ownership Corporate ownership Hospital Ownership Single-specialty Multi-specialty

JCAHO AAAHC Other:______________________

Check Enclosed (check number) _______________ Please make payment to MASCA.

Number of ORs:_______________ Number of Procedure Rooms:_______________

Annual Number of Procedures and Surgeries:_______________

Mississippi Ambulatory Surgery Center Association Membership Application

Facility: $1,000 Facility membership is reserved for licensed ASCs in the State of Mississippi

Corporate: $1,000 Corporate membership is available to those orginizations or companies that are in the business of providing supplies, equipment and services to ASC. Corporate membership is reserved for organizations that are not qualified to join as Facility members.

200 North Congress Street , Suite 500Jackson, Mississippi 39201

Phone: 1-800-936-4426Website: www.masca-ms.org