August 15, 2019

Industry Awareness

Why Patients Love ASCs

We all know the big patient benefits of ambulatory surgery centers through the anecdotal evidence patients provide. The personalization of care, reduced wait times, the high quality of care, and the typically reduced cost of care in comparison with other options are usually at the top of patients’ lists. It is not often, though, that we get study data to prove the point. The New Jersey Association of Ambulatory Surgery Centers has just had an independent study completed on ASC patients who have had surgery in the state within the last twelve months, with the goal of putting some data to patient satisfaction. Patients are extremely happy with their ASC experiences. According to the study, 99% of patients would recommend their New Jersey ASC to their family and friends.

CMS Rule Could Move More Medicare Patients to ASCs

In the US in 2016, just 15% of the 900,000 hip and knee joint replacements were performed in outpatient centers. That outpatient volume is expected to double in just a little over six years. ion.Overall, that is welcome news for the expansion of ASCs, though reimbursement rates have not been announced. With the expansion comes a CMS adjustment to quality reporting requirements to measure near-term unplanned patient hospital visits following these ASC procedures. Those CMS measurements, which will not kick in until 2022, are aimed to standardize ASC quality reporting.



2019 – The Year of Healthcare Consumerism?

We have been on an arc of more patient financial responsibility in US healthcare for several years. Has the trend finally culminated in 2019, moving providers to account for their patients in their revenue collection strategies? If so, it is not an easy transition, nor will it be complete in 2019. One of the big issues that remains to be solved is patient collection rates on larger out-of-pocket costs. A hospital study reported that patient collection rates drop by over 17% when patients owe more than $1,200 in out-of-pocket charges. Average patient financial responsibility rose 11% from 2016 to 2017.

Anthem Continues to Slash Payments

In early 2018, Anthem began steep payment cuts to various providers in many states and across several different provider types and procedures. Through cost-savings policies and practices, Anthem has been seeking to influence how patients would experience the health care delivery system. Anthem’s cost-cutting ways have continued to rankle providers deep into 2019. Pathology services and follow-up visits are the latest to experience Anthem’s deep cuts. In the case of pathology services, these are no light cuts. This payment slashing is a 70% drop from negotiated reimbursements. Provider groups have made concerted efforts over the past year that have temporarily adjusted Anthem’s actions, but in-network providers have little bargaining space.


Healthcare Digital Transformation Watch

Healthcare’s Embrace of Digital Transformation Lagging

In late 2018, Gartner released a predictive report on digital transformation in the healthcare marketplace. The report signaled a clear and compelling call to the industry that this is not a nice-to-have transformation, but in fact will be a need-to-have transformation. AI is moving more mainstream, corporate giants are entering the space, and healthcare consumers (patients and employers) will expect more control and access to healthcare on their terms. Gartner states that the industry is at a technology inflection point. The case of the digital haves and have nots is becoming acute, since the relatively few early digital transformation adopters are pleased with the results, but the majority of healthcare providers are lagging in their digital health readiness.



House of Representatives Votes to Repeal PPACA’s “Cadillac Tax”

by Sean Laffey, Contego Legal Analyst, from the office Jon Sistare, JD, Contego Attorney

While Texas leads the battle against the individual mandate portion of the Patient Protection Affordable Care Act, another part of the hefty law may soon be rendered extinct. On July 17, 2019, the House of Representatives voted almost unanimously (419 to 6) to repeal a cost containment provision of the PPACA, aptly dubbed “The Cadillac Tax.” The tax, meant to help pay for the ACA’s coverage expansion, was first set to go into effect in 2018. Congress has since delayed it twice, meaning that the tax is not set to go into effect until 2022. Simply put, the Cadillac Tax is a 40 percent excise tax on expensive employer plans and is designed to discourage high-cost employer-sponsored coverage.

The Cadillac Tax would have applied to plans with costs higher than around $11,000 for single coverage and around $29,000 for other coverage starting in 2020. It is worth noting that the vast majority of employer-provided plans cost less than these thresholds. In fact, The US Treasury Department has estimated that just 4 percent of plan enrollees and 1 percent of plan costs would be above those thresholds in 2020 (in a world without the Cadillac Tax). The goal of the tax would be to discourage excessive and needless use of healthcare benefits, which would in turn drive up costs for everyone. If workers have expensive plans with minimum cost sharing provisions, they are more likely to seek healthcare treatment that they do not need.

Proponents of the Cadillac Tax argue that it is an important cost containing measure, as it is estimated to save $1.2 trillion over the next two decades that would otherwise be applied to the nation’s deficit. However, critics assert that the tax would inadvertently hurt individuals and families who already struggle to afford their existing premiums. As CEO Matt Eyles of America’s Health Insurance Plans puts it: “this [repealment] will help lower deductibles, improve health care access and make coverage more affordable for hundreds of millions of hardworking Americans. We urge the Senate to follow suit and pass this bill to improve health care affordability for every American.”

While the fate of the PPACA as a whole remains uncertain, it is highly likely that this dormant tax will never awaken to see the light of day.


At a Glance

August Is National ASC Month!

National Association Helps ASCs Raise Awareness

Dr. Dan Lieberman on ‘Delivering a World-Class Patient Experience’

Surgeon-Owner’s Take on Patient Experience

Even Student-Run News Outlets Recognize Their Need for Podiatrists

Three Signs It Is Time to Visit

Promoting Your Centers’ Digital Assets

Advances in Healthcare Texting Technology


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