July 15, 2019

Industry Awareness

Data on Total Joint Replacements

We are all aware that total joint replacements are both quicker and cheaper to perform in ASCs than in hospitals. Have you ever wondered just how much? According to a March report from the American Council on Science and Health, total joint replacement cost is 40% lower in ASCs. Average surgery costs dropped from $19,361 in hospitals to $11,677 in ASCs. One reason is the time involved in surgery. According to this report, the average time required for total joint replacements is 65% less in ASCs than in hospitals. These are big drivers of patient satisfaction with ASCs.

More ASCs in Higher Acuity Specialties

Total joint surgeries are not the only higher acuity specialties driving more patients to ASCs. CMS’s 2019 payment rule allowed ASCs 12 additional cardiac catheterization diagnostic procedures and five other complementary cardiac procedures. Private payers are showing a willingness to pay, so more of these procedures are likely to migrate to ASCs in the near future. Likewise, more spine patients are heading to ASCs. Interest in ASCs for spine surgeries is growing among both providers and patients. The ASC experience is highly focused and deeply personalized for patients. As these higher acuity specialties shift to ASCs, surgeons are highlighting the wisdom of thoughtful patient selection.



Patient Financial Responsibility Rising Quicker than Health Care Costs

Out-of-pocket health care costs are rising even though patients are transitioning to lower cost care settings. Medical costs are continuing to rise at a 5% net growth rate, mostly driven by the pervasiveness of chronic disease, heavy drug spending, and an increasing interest in mental health services. The downward trend in hospital reimbursements has many looking to patients as a further source of income, embroiling hospitals and non-paying patients in debt collection suits. While general medical costs are rising at an annual 5% growth rate, patient financial responsibility grew 17% from 2017 to 2018, making health care consumerism a top priority for providers in 2019.

Executive Order Fast Forwards Transparency Movement

On June 24, the president signed an executive order squarely aimed at improving price visibility for patients. The rule requires hospitals to publish prices that reflect what patients actually pay. The administration believes the order will lead to a better competitive healthcare environment that will reduce costs and improve quality. The executive order is effectively accelerating a movement mostly led by states over the last decade. The Right to Shop Initiative video from the Foundation for Government Accountability in Texas demonstrates those state efforts. The executive order seeks to get closer to providing patients with real pricing information, but obtaining that information is still a significant challenge. Lawsuits are likely to delay action on the order beyond the upcoming presidential election cycle.


Revenue Cycle Technology

Revenue Cycle Tech Strategies

Technology strategies are proliferating in healthcare and executives are noticing. 76% of healthcare executives are planning to invest in revenue cycle predictive analytics by 2020. As patient out-of-pocket costs rise the prospect of collecting payments drops, creating a greater need for pinpointing revenue cycle breakdowns. More healthcare providers are also seeking ways to apply intelligent automation solutions like artificial intelligence (AI) and robotic process automation (RPA) to develop more effective revenue cycles. Forward-looking providers are working toward patient centered approaches in their revenue cycle tech strategies so they optimize patient engagement.



Medical Device Failure Was Concealed for Years. What Happens Now?

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

The highly anticipated showdown over the future of the Patient Protection Affordable Care Act finally took place in a New Orleans federal courtroom on Tuesday, July 9. This case presents several interesting and high-stakes circumstances, not least of which is millions of Americans potentially losing health insurance coverage either partly or entirely. After an hour and a half of testy interrogation by the three-judge panel sitting for the Fifth Circuit, it remains unclear how the bench will rule. Either way, we can be sure this case will be submitted to the Supreme Court for review during what is already a politically fraught time, setting up perhaps the biggest battle over access to healthcare since the creation of Medicare in 1965. It is difficult to overstate the impact a ruling against the PPACA could have on both patients and providers.

Arguing for the 18 Republican states seeking to invalidate the embattled PPACA, Texas Solicitor General, Kyle Hawkins, and Department of Justice Attorney, August Flentje, emphasized that because the individual mandate was initially deemed an essential part of the law and has since been repealed, the entire law no longer stands. This itself is a tenuous claim, because established case law mandates that entire laws cannot be struck down when only one section is in question. This side faced even greater skepticism when they suggested that the PPACA could just be invalidated in the 18 states challenging the law. As there is virtually no precedent for a federal law applying in some states but not others, it is unlikely this argument convinced the panel.

On the other side, California’s Deputy Attorney General, Samuel Siegel, and US House of Representatives Counsel. Douglas Letter, reminded the panel that when the individual mandate was repealed in 2017, Congress chose to leave the rest of the PPACA intact; indicating that it believes the rest of the law can and should continue to exist. Although the panel did not appear swayed by this argument, they were receptive to the fact that tens of millions of Americans, especially those with preexisting conditions, stand to lose affordable coverage if the law is overturned with no functional replacement likely to pass in time. The panel is expected to issue its ruling on the constitutionality of the PPACA within a few months, and the rest of the healthcare industry will be waiting anxiously until then to plan for a future that could include, among other unknowns, more uninsured or underinsured patients and unpredictable fluctuations in reimbursements.


At a Glance

Top of Mind Issues for Health System Leaders?

Reducing Cost and Improving Patient Experience

In Win for Pharma, Administration’s TV Drug Price Disclosure Plan…

 Foiled by US DC District Court Ruling

Kaiser Permanente Easing the Way through Med School

Drops Med School Fees for First Five Years of New School

How to Have Those Tough Cost of Care Discussions

Pragmatic Strategies for Patient Financial Portion Conversations


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