CMS Finalizes ASC Burden-Reduction Strategy, Academy Nets Advocacy Win

The Centers for Medicare & Medicaid Services is following through with a strong plan to eliminate obsolete administrative requirements, this time benefiting ambulatory surgery centers and their patients. The Academy in December urged CMS to drop the requirement for comprehensive preoperative physical examinations, which are irrelevant to eye surgery. In a final rule on the issue, the agency eliminates this requirement, replacing it with one that offers ASCs greater flexibility to determine which patients and surgeries are low risk. 

The agency advanced this plan as part of its ongoing Patients Over Paperwork initiative, which strives to eliminate barriers between physicians and those seeking care. It says that its Omnibus Burden Reduction (Conditions of Participation) Final Rule strengthens patient safety by removing from Medicare unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. 

We endorsed this plan because it would allow ASCs to create their own policies for presurgical medical histories and physical examinations — including associated testing. 

In its new policy, CMS is: 

• Finalizing the proposal to revise the comprehensive preoperative physical examinations requirement to state, “Significant medical history and results of physical examination, as applicable” 

• Finalizing the proposal to eliminate the requirement for each patient to have a medical history and physical assessment completed by a physician not more than 30 days before the scheduled surgery and replace it with the requirement for ASCs to develop and maintain a policy that identifies those patients who require a medical history and physical examination prior to surgery 

• Revising current policy to clarify that the ASC rules must be based on nationally recognized standards of practice and guidelines and applicable state and local health and safety laws 

The policy is consistent with the Academy’s Choosing Wisely initiative, by which we support eliminating preoperative medical tests for eye surgery unless there are specific medical indications. In fact, when issuing its draft rule, CMS cited cataract surgery and YAG capsulotomy among its primary motivators for this change. 

CMS is also eliminating another requirement opposed by the Academy, which required facilities to have a written transfer agreement with a hospital or ensure that all physicians have admitting privileges in a hospital. The agency has instead decided it will require ASCs to periodically provide the local hospital with written notice of its operation and patient population served. Many ambulatory surgery center owners have told the Academy that it is difficult to secure these arrangements from hospitals. Lacking the transfer agreement or admitting privileges can cause ASCs to fail Medicare’s compliance requirements.