May 15, 2019

Industry Awareness

Growth of ASCs

The number of new ASCs is increasing at a 2.4% annual rate as of the last CMS reporting. Geographic distribution of ASCs is quite uneven due to a variety of factors, including state policy differences. Maryland enjoys the highest distribution of ASCs at 40 per Medicare Part B beneficiary, while Virginia has only half that many. Drive over to West Virginia, which neighbors both, and the rate sinks to four ASCs per Medicare Part B beneficiary, among the lowest rate in the nation, which also reflects the variable growth rate due to population density. A wide variety of ASCs are opening in population centers. The first standalone reproductive ASC is making news in the state of New York as is the opening of a new orthopaedic ASC. Several orthopaedic ASCs have announced their openings in recent months in higher population density areas in the eastern third of the country.

A Few ASC Stats to Know

MedPAC has released its 2019 ASC report to the U.S. Congress, which is loaded with statistics, including the statistic that Medicare payments to ASCs per beneficiary rose 7.7% in the last year measured. Pain management ASCs are the fastest growing during the 2015-2017 measurement period. According to MedPAC, patients are finding ASCs more convenient and easier on their healthcare spending than hospitals when it comes to surgical procedures. Perhaps not surprising, California, Florida, and Texas have the highest total number of ASCs, though not the highest number by percentage of population. Even though consolidation always gets an inordinate amount of news, independent physician groups own 70% of ASCs.



Relatively Small Numbers of Payers Dominate Private and PPACA Markets

With the advent of PPACA in 2010, many hoped that the payer community would expand. It has not. In fact, while a small number of payers dominate private health insurer markets, payers are even more concentrated on the PPACA exchanges. The Government Accountability Office has found that three or fewer payers own at least 80% of private plans in 37 states and of PPACA exchange plans in 46 states. Blue Cross Blue Shield insurers have traditionally remained aloof from increased concentration, but BCBS insurers in North Carolina are combining, which could lead to more consolidation within BCBS.

Health Care Price Transparency Advances

Health Care price transparency is now an issue the federal government is addressing. Senate lawmakers are examining proposals to empower patients through upfront price comparisons. The ultimate goal is to provide this information digitally so patients can do significant price and quality comparisons on their smartphones. However, the specifics of creating such an app are unclear and time to market could be years. By the end of this summer, expect to see changes in the way pharmaceutical companies disclose pricing in their televised ads.


Revenue Cycle

Outsourcing Medical Billing is Gaining Traction

A 2018 survey of practice staff conducted by medical office software provider, Kareo, found that 28% of health care providers are likely to outsource their medical billing in the next two years. Revenue Cycle Management (RCM) services are growing at a 12% per year clip and are expected to grow at a 20% rate in the very near future. Medical billing companies tend to be young (26% have been around fewer than two years) and focused on specific medical specialties. The demand for RCM outsourcing is even greater among hospitals, with a recent survey revealing that 80% of hospital leaders are considering outsourcing in the immediate future as a means of cost reduction and reimbursement production.



Regulatory Trend Continues Under New FDA Chief

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

It appears that the recent trend of enforcement action against unscrupulous providers will continue under recently appointed Acting Commissioner of the FDA, Dr. Ned Sharpless. A transplant specialist from the National Cancer Institute, Dr. Sharpless highlighted the FDA’s enforcement goals during remarks at the Food and Drug Law Institute a few months ago. He replaces outgoing commissioner Dr. Scott Gottlieb, who had also made enforcement a key aspect of his two-year tenure. While Dr. Sharpless specifically singled out providers such as opioid marketers and distributors, dietary supplement manufacturers, and stem cell clinics, which fall under the FDA’s purview, more and more providers across a wide array disciplines have found themselves under similar scrutiny from both regulators and payers.

This conforms to the overall nationwide trend of both government agencies and courts aggressively pursuing fraudulent providers in an effort to clamp down on spiraling costs and increase patient safety. Several notable cases have reached conclusions recently; in Boston, the makers of a fentanyl spray for pain management were found guilty of racketeering, and several other cases against opioid manufacturers are playing out across the country. As the FDA and other government agencies continue these investigations, all providers should take the opportunity to review best operating practices and ensure compliance with applicable laws and regulations moving forward.

At a Glance    

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