On July 15, 2022 the Centers for Medicare and Medicaid Services (CMS) released the 2023 Ambulatory Surgical Center Quality Reporting Program (ASCQR) Proposed Rule. This blog post breaks down the proposed changes to the ASCQR and requests for feedback.

2023-2024 Proposed Changes

CMS is not proposing any changes for the 2023 and 2024 reporting periods.

2025 Proposed Changes

CMS is proposing to make the following measure voluntary: ASC-11: Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery

• Last year, CMS finalized a policy to require ASC-11 beginning in 2025. In response to continued stakeholder pushback, particularly surrounding the significant burden this measure would add as ASCs continue to experience staffing shortages due to COVID-19, CMS is proposing to suspend mandatory reporting of this measure.
  
  • Ophthalmic specialty societies have opposed this due to the inappropriate nature of these surveys being attributed to the ASC facility rather than to the individual surgeon and the burdensome nature of patient surveys, particularly in this context. This would require the ASC to report on data that is located in the surgeon's office and, thus, inaccessible by the ASC as, per Medicare ASC Conditions for Coverage, the two entities must be physically, administratively, and financially separate from one another.
  • We anticipate CMS will propose to make this mandatory again in a future rule and that this measure will continue to be challenged in future years.

Requests for Comment on Potential Future Changes

CMS included three significant requests for comment in this proposed rule. These are changes under consideration for proposal in a future rule. Comments submitted to CMS on these topics have the potential to impact future proposed changes as they are in development.

Potential Future Specialty Centered Approach for the ASCQR Program

CMS is considering implementing a specialty-centered quality reporting approach for ASCs that is similar to MIPS quality reporting. Specifically, CMS is requesting comment on a couple of approaches under consideration:

• Creating measures sets related to different specialities. 
  • Under this approach, the ASC could choose a specified number of measures from the sets of measures that represent its specialties.
• Creating specific, specialized reporting tracks which would standardize the quality measures required to be reported for each specialty.

Both of these approaches would include quality measures more similar to what is seen in MIPS. CMS also believes these approaches would benefit from promoting subgroup reporting. Subgroup reporting allows single specialty subgroups in a larger group (e.g., all ophthalmologists in an ASC) to report separately on a specialty-specific set of measures.

CMS specifically calls out ophthalmology as an example of a specialty that would be impacted by these potential future changes.

Potential Future Reimplementation of ASC Facility Volume Data on Selected ASC Surgical Procedures (ASC-7) Measure or Other Volume Indicator

CMS is considering reimplementing ASC-7 to track procedure volumes for public reporting. This is a measure of facility capacity and surgical procedure volume data on six categories of procedures frequently performed in the ASC setting: Gastrointestinal, Eye, Nervous System, Musculoskeletal, Skin, and Genitourinary. CMS states that volume is an important component of quality as higher procedure volume is associated with better outcomes. By making this metric viewable on Care Compare, CMS believes that patients will be able to make more informed choices.

Interoperability Initiatives in ASCs 

CMS wants to promote meaningful electronic health record (EHR) use in ASCs. They site a 2021 Ambulatory Surgical Center Association EHR utilization survey, showing that 54.6% of ASCs use an EHR in their facility, indicating that ASCs have a lower adoption rate compared to the 85.9% of office-based physicians reported by ONC.

Steps CMS is considering toward this goal include:

• Transitioning from reporting in QualityNet to electronic clinical quality measures (eCQMs)
  • CMS is also considering requiring reporting on the Safe Use of Opioids eCQM
• Requiring ASCs to report on scored EHR objectives
• Applying existing MIPS Promoting Interoperability measures to ASCs
  • e-Prescribing
  • Query of the Prescription Drug Monitoring Program

• • Health Information Exchange
    • Receiving and Reconciling Health Information
    • Sending Health Information
    • Bi-Directional Exchange
  • Provide Patients Electronic Access to Their Health Information
  • Security Risk Analysis

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