1. Government & Public Affairs Update—Texas ASC Association Annual Meeting Chris Kelly SVP and General Counsel to AmSurg Chair, ASCA Government Affairs Committee

2. ASCA’s Advocacy & Public Affairs Focus – Recent Successes – Research – Legislative Priorities – Regulatory Outreach – Advocacy Involvement

3. Recent Successes Conditions for Coverage – Same Day Surgery Eliminated – Radiologist on Staff Modified Addition of 4 Procedures in 2014 Final Rule – 27415 (Osteochondral knee allograft) – 27524 (Treat kneecap fracture) – 60240 (Removal of thyroid) – 60500 (Explore parathyroid glands) Delay of Ophthalmic Quality Measure (ASC-11) Nevada Hospital Association Petition

4. ASC Payment Updates Compared to Other Providers The McManus Group Payment Updates from 2010 to 2014 Source: Center for Medicare and Medicaid Services *Sequester cuts not included in shown payment updates

5. Research UC-Berkeley Study OIG Report Health Affairs Study

6. UC-Berkeley Study Top 120 procedures 2008-11 - $7.5 billion savings, with $1.5 savings for beneficiaries 2011 - $2.3 billion in savings Potential 10 year savings - $57.6 billion

7. April 2014 HHS OIG Report – March 2011, at request of ASCA, W&M Subcommittee Chairman Herger requests OIG to examine potential savings from ASCs and implications of hospital acquisitions – OIG found that ASCs saved the Medicare program $7B from 2007-11 – ASCs have the ability to save an additional $12B under the current payment structure between 2012-17

8. Health Affairs Study on ASCs Munnich & Parente study published in Health Affairs May, 2014 Procedures at ASCs take 31 minutes or 25% less time in ASCs than hospitals – This translates to $363 - $1,000 savings per case High-risk Medicare patients treated in an ASC were less likely to visit ER than similar patients for same procedure treated in a hospital Enactment of ACA and demographic trends require ASCs to accommodate growing demand of outpatient surgery

9. Federal Legislative Agenda ASC Quality and Access Act Electronic Health Fairness Act Removing Barriers to Colorectal Cancer Screening Act

10. ASC Quality & Access Act (HR 2500/S 1137) Sen. Ron Wyden & Sen. Mike Crapo Rep. Devin Nunes & Rep. John Larson CPI-U to Hospital Market Basket Authorizes Value Based Purchasing for ASCs Transparency in Procedures List Adds ASC Rep on Advisory Panel on Hospital Outpatient Payment

11. ASC Quality & Access Act (HR 2500/S 1137) – Cont. 76 current sponsors/co-sponsors in House 10 Members of the Texas Delegation 8 current sponsors/co-sponsors in Senate

12. H.R. 5556 – Electronic Health Fairness Act Rep. Diane Black (R-TN) 2015 – 50 percent threshold for physician “Meaningful Use” and ASC encounters counted Directs CMS to certify an EHR for the ASC setting Exemption for patient encounters in ASCs until CMS certifies EHR

13. H.R. 1070 – Removing Barriers to Colorectal Cancer Screening Act Rep. Charlie Dent (R-PA) Medicare preventive screening colonoscopy Waives co-pays if polyps discovered during the procedure 129 Co-Sponsors in the House

14. Membership Participation Critical Inform and educate your lobbyists Respond to legislative/regulatory alerts and communicate with policymakers – Ask Reps and Senators to co-sponsor ASC legislation – Submit comments to CMS on ASC rules Facility Tours – Goal 50 in 2014 Capitol Fly-ins (2015 tentative dates) – June 16-17 – September 29-30 ASCAPAC/Advocacy Fund

15. If every ASCA member gave $750 a year, it would total $4.5 million Every two years, the hospital industry contributes OVER $5 MILLION. In the same period, ASCAPAC collects $300,000.