ASCs in Motion Newsletter - Contego Solutions

October 15, 2019

ASC Industry Awareness

2019 ASC Market Growth to Date

The U.S. ASC market is enjoying a significant growth spurt in 2019, as it has for the past couple of years. If you like your ASC growth information by month, click here. If you are more inclined to view it by state, click here. Independent physicians, management companies, and hospital systems are each carving out space inside this growth. You will notice the same in this list of the year’s 21 new orthopaedic ASCs. Cardiac ASCs are starting to make their mark with six beginning this year. In addition, ASC procedure volumes are predicted to increase by up to seven percent annually through 2021. The significant growth in ASCs creates new challenges and new opportunities for medtech companies.

Growth Comes with Increased Data and Ransomware Attacks

As ASCs grow in the public awareness in 2019, exposure to data and ransomware attacks also grows. Four different centers from four different areas of the country (urban and rural) are the subjects of unwanted data attacks. Columbia Surgical Specialists (Spokane, WA) paid nearly $15,000 to ransomware attackers to unlock encrypted files that affected 400,000 patients. In small town down state Swansea, IL, Quantum Vision Centers was hit with a malware attack that encrypted files on a server containing patient health information. Gillette, WY Powder River Surgery Center is warning patients about potential scams following a ransomware attack on its 1,500 computers in September. In April, Clearway Pain Solutions Institute in Pensacola, FL sustained an EMR data breach that exposed 35,000 records.

Healthcare Industry Trends

Modernizing Medicare Payments for ASCs

2017 marked the first year that over half of all surgeries in the United States were performed in ASCs. ASCs perform those surgeries at a cost 35-50% lower than hospitals, saving the healthcare system $40 billion annually. That savings has not returned to ASCs in the form of better Medicare payments (note 2019 CMS ASC payment notice). That may be about to change. Medicare payments to hospital outpatient departments are nearly double those paid to ambulatory surgery centers. ASCs have not had any bump from CMS in six years. H.R. 4350 would amend title XVIII of the Social Security Act to level the playing field, to modernize ASC payments, and to ensure that Medicare patients continue to have access to the high quality of care ASCs provide.

Walmart, Amazon, Best Buy, Groupon Enter Healthcare While Hospitals Exit

Walmart Health has just taken a big leap in healthcare beyond pharmacy, where it has been for a while. Last month it unveiled its first remodeled supercenter with a health center. As an internet deal retailer, Groupon is selling coupon deals for healthcare services n their website. Walmart is also rebuilding its workforce, moving it toward healthcare service. Best Buy is moving into health monitoring services for seniors. Amazon has a new employee virtual medical clinic and is moving toward the healthcare provider market – all while rural hospitals are struggling and exiting the market.

Healthcare Digital Transformation Watch

Healthcare Vulnerabilities

According to a major Verizon data breach report, healthcare is the only industry where the majority of breach damage comes from insiders – ouch! When 58% of breaches come from internal sources, healthcare faces a significant liability. Unfortunately, that is not the only area of susceptibility. Old code is making medical devices vulnerable, which is frustrating in a normal office or household product, but potentially lethal in healthcare. Virtual care and remote monitoring are picking up steam, also presenting areas of susceptibility. Coming full circle to healthcare staff vulnerabilities, 24% of U.S. healthcare staff haven’t received cybersecurity training and 40% of North American healthcare staff aren’t aware of their own organization’s cybersecurity efforts.

Legal

Transparency in View with STOP Surprise Medical Bills Act

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

It seems rare these days that both Democrats and Republicans unanimously support an issue, but such is the case with S.B. 1531. This proposed Act, called the STOP Surprise Medical Bills Act of 2019, seems to be gaining traction after first being introduced by Senators Patty Murray and Lamar Alexander. The goal of the act is to protect Americans from the common issue of “surprise billing” which can lead to anxiety and severe debt for unaware patients. For example, if a patient receives services at a hospital that is in-network with their insurance carrier, yet an assistant is out-of-network, they could receive an out-of-network bill while under the impression that everything would be process as in-network.

The act calls for additional clarity in these types of situations so consumers are aware when out-of-network providers are part of their service team and of the resultant out-of-pocket costs (which may be more or less than with an in-network provider). Senator Michael Bennet, a proponent of the proposed act, says that “The last thing a patient should have to worry about is being blindsided by unanticipated, and potentially financially devastating, medical bills. People deserve to know how much they are paying for health care services and procedures at the point of care.” The act is currently still in the Senate, headed by Senator Bill Cassidy, awaiting input from the Committee of Health, Education, Labor and Pensions. If passed, new regulations could be applied to providers and patients may have access to the transparency for which they have so long been advocating.