Quality Reporting for Ambulatory Surgery Centers (ASCs)

The Academy supports appropriate quality reporting measures for ambulatory surgery centers. However, we have opposed the inclusion of measures that were not designed for the facility setting or that are not applicable to certain surgical specialties performing procedures in the ASC setting.

Specifically, the Academy opposed the inclusion of measure ASC-11 — Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery — in the ASC Quality Reporting Program. Although the Academy developed this measure, it was designed for use in the Physician Quality Reporting System, not for facility-level reporting. While reporting ASC-11 is currently voluntary, the Academy has urged the Centers for Medicare & Medicaid Services (CMS) to remove the measure from the program entirely.

The Academy, the American Society of Cataract and Refractive Surgeons (ASCRS), and the Outpatient Ophthalmic Surgery Society (OOSS) have jointly submitted alternative quality measures to CMS that are appropriate for the facility setting.

One of these measures — related to Toxic Anterior Segment Syndrome (TASS) within two days of undergoing anterior segment surgery in the ASC— was submitted to a national consensus-based entity for endorsement, and CMS has indicated it will consider the measure for inclusion in future years of the Ambulatory Surgical Center Quality Reporting (ASCQR) Program. The Academy will continue to work with CMS toward adoption of quality measures that are meaningful, accurate, and appropriate for ophthalmic surgical care in the ASC setting.

The majority of ophthalmic surgical cases in the United States are performed in ambulatory surgery centers. Under the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, ASCs must report on a set of quality measures determined by CMS. Facilities that fail to report face a 2% reduction in their Medicare payments — even when certain measures are not applicable to their specialty.

The required measures have changed over time as CMS has modified the number and type of metrics included in the program. In 2014, CMS introduced ASC-11, a cataract-specific measure assessing improvement in patient visual function within 90 days following cataract surgery. The Academy opposed its inclusion, noting that the measure was developed for use in the physician reporting context and was not designed for facility-level reporting.

Following opposition from the Academy and other organizations, CMS suspended ASC-11 as a mandatory measure and reintroduced it as a voluntary measure in 2015. The measure is no longer a central component of the ASCQR Program, and CMS has stated it will not penalize ASCs that did not report it.