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10 ASC MANAGEMENT ASCs could start providing 131 more device-intensive procedures for Medicare patients if CMS approves rule: 5 things to know By Laura Dyrda C MS proposed several updates to ASC payments in the 2019 proposed pay- ment rule, issued July 25. One of the key changes for ASCs would be to broaden the definition of device-intensive procedures, adding 131 procedures for Medicare benefi- ciaries in the ASC setting. Here are five things to know: 1. CMS proposed updating the definition of device-intensive procedures from procedures where the device is 40 percent of the overall cost to 30 percent of the overall cost for the proce- dure in the hospital outpatient department. 2. e lowered threshold is expected to make it economically possible for ASCs to provide 131 device-intensive procedures to Medicare beneficiaries for the first time. "[is is] a policy change we have been advocating for over the past several years to encourage migration of these procedures into ASCs," said Ambulatory Surgery Cen- ter Association CEO William Prentice in a Q&A posted on the organization's website. 3. e new definition of device-intensive would increase the number of device- intensive procedures that ASCs can afford to provide to Medicare beneficiaries from 154 to 285 procedures for 2019, if it appears in the final rule. 4. Among the newly approved cases would be several cardiac procedures. e proposed payment rule would also revise the definition of "surgery" for ASC payments to include "surgery-like" procedures, which would add 12 cardiac catheterization procedures to the ASC list as well. 5. For device-intensive procedures, the total cost of the device is included in the reim- bursement rate for ASCs. n Inventory management & other supply chain challenges: 3 Qs with ASC expert Lacey Dyer By Angie Stewart S urgical Investors and Advisors' Vice President of Clinical Operations Lacey Dyer, RN, BSN, is an expert in selecting and purchasing equipment, instrumenta- tion and supplies specific to ASCs. With more than 15 years of consulting experience in ASCs, Ms. Dyer shared her insights on inventory manage- ment with Becker's ASC Review. Note: Responses have been lightly edited for style. Question: What are the most common mistakes ASCs make regarding inventory management? Lacey Dyer: The most common mistake I see in develop- ing and managing ASCs is not prioritizing the purchase and development of an inventory management system. Waiting too late in the development phase to begin the process of inventory management will set the center up for mistakes and [cost] opportunities for savings. These systems take a significant amount of effort to set up and develop, so it's best to start the process early. Another problem can be standardizing products prior to having multiple products in facilities. When ASCs are starting to open, the mindset can be "just get what the surgeons have used in the hospital," but decision makers need to be more careful in selecting the right equipment because once something is in the facility it is difficult to get it out. Q: What are the key differences between ASCs and hospitals when it comes to equipment selection and purchasing? LD: The purchase process and layers to approval are much less in an ASC. The volume and variations of prod- ucts are also significantly less, so attention to cost has a big impact on the bottom line. In general, ASCs are under mandated spending caps depending on the state and the structure of the organization, which requires the facility to closely monitor all spending. For this reason, new services or equipment purchases are scrutinized on several levels prior to development. Additionally, owners and physicians are intimately involved at the purchasing level and are considering equipment from companies like Mizuho OSI, which offers specialty surgical equipment that reduces surgeon fatigue and improves postoperative outcomes for patients. Along with this is the multitasking of the facility staff, as many centers have the operating room personnel in charge of purchasing. Q: How do these differences pose unique challenges? LD: Communication is key. Reviewing the overall budget from the start and helping the team see the different products, cost and service will reduce frustrations down the road as items are evaluated. Also, ASCs should allow the time for personnel in charge of purchasing to learn their role in the fast-paced ASC environment in order to make the best decisions when it comes to equipment purchasing. n