January 15, 2019

Industry Awareness

2018 a Banner Year for ASC!

2018 proved to be a year of solid advances for ASCs in our country. The Medicare final rule adopted policy changes that will put ASCs on more of an even reimbursement footing with HOPDs. A new price lookup tool compares Medicare costs for some ASC and HOPD procedures, which gives patients data to make better-informed decisions. Payments for knee surgeries in ASCs were studied and proven to be significantly lower than the same surgeries in HOPDs. Still more procedures are finding their way to consistency in the ASC setting. In 2018, cardiac procedures were added. On the opioid front, the ASCA developed a resource center to assist clinicians in moving their patients away from opioid use.


Payers, Not Just Providers, Have Wide Gaps in Prices

The National Bureau of Economic Research studied price variation between health insurers and found that though popular media typically presents price gaps as a provider issue, they are just as much a payer issue, it’s just harder to observe across payers (for abstract do NBER site search on “How Important Is Price Variation Between Insurers”). Between-payer variation and between-provider price variations are similar in effect. Healthcare prices were found to vary widely between both geographic markets and even among same-area providers. These variations can lead to more spending out-of-pocket and higher employer costs. Healthcare spending grew 5% in 2018. Spending is growing faster by private payers even though total healthcare price growth remains below 2% and below the U.S. rate of inflation.



Making More out of Data in Healthcare

Increasing awareness of the beneficial uses data, artificial intelligence, machine learning, and blockchain are bringing added value throughout the healthcare system including in the ASC world. The volume of data has grown over the last several years and now healthcare organizations are seeking to turn it into positive activity. Through data, ASCs can optimize utilization, improve surgical outcomes, have more leverage to negotiate better insurance contracts, and market to potential patients. Contego is also making more use out of data and technology services to continually deepen reimbursement capture capabilities for clients.


Price Transparency More Widely Embraced

State efforts, federal efforts, insurance company efforts, and the efforts of ASCs and healthcare organizations are moving the entire U.S. healthcare system toward price transparency. Twenty ASCs have gone on record, posting at least some of their prices online. Price transparency creates some additional leverage for ASCs and some are taking action by asking patients to rate shop at hospitals. Even though federal efforts at price transparency are fraught with challenges, the new federal price transparency compliance rule adopted in 2018, just went into effect January 1. The Pharmacy & Therapeutics Journal makes the case that healthcare price transparency initiatives are all the rage headed into 2019.


Revenue Cycle

Family Matters in Revenue Cycles

It has now been demonstrated that for families, healthcare spending is very sensitive to cash flow events. Consumers wait for infusions of cash and then immediately increase their use of health services. Short-term financial factors loom large for many families in making health decisions. Immediate cash shortages have been shown to delay care for people at all income levels. This is especially of concern since out-of-pocket healthcare costs are on the rise along with high deductible plans. 17% of families delay care and make at least one large healthcare payment a year, placing downward pressure on providers’ revenue cycles. Providers may need to consider payment programs in order to spread out care and reimbursements more appropriately.



The Year Ahead: Trends and Expectations

by Laura Raymond, Contego Paralegal, from the office Jon Sistare, JD, Contego Attorney

2018 was a tumultuous year in the healthcare legal field, and 2019 is on track to continue that trend. Perhaps the biggest question looming over the industry is the status of the Affordable Care Act, also known as Obamacare. Declared unconstitutional in its entirety by a Texas district court judge in December 2018, the ACA still stands, as is pending appeal. But what is bound to be a contentious case is expected in court later this year, with huge ramifications for both providers and patients hanging in the balance. Though many experts expect that the ruling will be overturned, it is indicative of a larger trend of moving away from the ACA’s core provisions. The individual mandate has already been effectively canceled, and President Trump in 2017 reopened the door to short-term limited duration insurance plans, which cover less for shortened periods of time. Continued erosion of the ACA could have unpredictable, far-reaching consequences for the healthcare landscape as a whole.

Outside the judiciary, ASCs specifically may find themselves subject to additional scrutiny following the introduction of the Hospital Price Transparency and Disclosure Act of 2018 (HB 6508) in the House of Representatives. This bill would require hospitals and ASCs to publically post semiannual disclosures of the average insured and uninsured charges for the 100 most commonly billed procedure codes. A similar bill stalled out in 2012, so it remains to be seen if this one will make it out of committee, where it currently sits. CMS is also still weighing whether to remove several regulations identified as ‘unnecessary, obsolete, or excessively burdensome’, including 8 quality reporting measures for ASCs as well as the need for ASC physicians to compile a patient’s comprehensive medical history and to have hospital admitting privileges or transfer agreements in order to perform surgery. These moves toward deregulation have been lauded by the industry, and could help to streamline operational and compliance processes as ASCs look to expand the services they can offer and optimize efficiency.


At a Glance