November 15, 2019

ASC Industry Awareness

On Independence, New Openings, and the First Leapfrog

Dr. Brian Gantwerker, California-based board-certified neurosurgeon, founder of The Craniospinal Center of Los Angeles and dedicated advocate of direct patient care through physician independence, went on record earlier this month about the arduous process of building a private practice and the challenges of dealing with insurance. Even so, he says if he were coming out of med school today, he would do it all the same way again. There are ASCs opening that are doing it the physician-owned way, or with financial partners. Half of the 18 new ASCs either opened or announced this October are at least physician-partnered, if not straight out physician group-owned. And yes, as planned, Leapfrog has produced its first ASC report, finding some quality measures lagging. However, Leapfrog’s grading for hospital safety is more concerning.

Majority of Spine and Ortho Surgeries in Outpatient Centers in 2020

Treatment advances, technology advances, size advantages, patient preferences, and CMS payment changes have all combined to push ASCs and outpatient surgery centers to deeper public acceptance. ASCs and outpatient centers will outpace hospitals in the number of spine and orthopaedic surgeries performed in 2020. CMS will pay for total knee arthroplasty surgeries in 2020 and boost their outpatient payment rate 2.6%. You can find further info on the final 2020 CMS rules for outpatient centers here. In another indication of the wide acceptance of the work of ASCs, in 2020 CMS will start to pay for certain coronary intervention procedures.


Healthcare Industry Trends

Price Transparency a Growing Feature

Due to our US third party payment system, full healthcare price transparency is a challenge. Nevertheless, the Executive Order on Healthcare Price Transparency and state efforts are increasing levels of price transparency. 75% of patients that have access to price data are taking advantage of it ahead of their care. November 4, Florida governor Ron DeSantis became the latest state governor to announce efforts to increase healthcare price transparency and to put a system in place to support it through the Florida Health Finder. State and federal transparency efforts are still in their early stages.

Financial Challenges for Hospitals

As ASCs take on more surgeries and payment structures shift, some hospitals are finding the going difficult if not altogether impossible. Federal hospital reimbursements are slated to take a $252 billion hit by 2029. Fiscal difficulties for hospitals first started to mount in rural areas in 2017, but now urban area hospitals are also curtailing services, filing bankruptcy, or closing. Holy Cross Hospital in Chicago has been losing $2 million a month and is dropping over 60% of its beds. Dwindling patient volumes are bringing 100-year-old St. Luke’s Medical Center in Phoenix, AZ to a close later this month. At least 22 hospitals in a wide range of areas have closed to date in 2019. The future of hospitals in the US is likely to be significantly different than our recent history would suggest.


Healthcare Digital Transformation Watch

Hacking Healthcare

Among the most dangerous trends in Health IT coming from these five Health IT executives is the real and potent concern of healthcare cybersecurity. The concern is particularly acute in healthcare because hacking problems are not only costly, they can bleed over into patient health and well-being. Common data hacking vulnerabilities include the need to update technology and applications as well as less than reliable data storage. The rush into health apps is spurring privacy fears that may also overlap into cybersecurity concerns. That fact that healthcare organizations are lagging behind many other industries in cybersecurity adaptation poses significant challenges.



Transparency in View with STOP Surprise Medical Bills Act

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

The Centers for Medicare & Medicaid Services have proposed new payment rules that would come into effect next year. These rules reflect an effort to update payment rates for outpatient and physician services while expanding cost transparency. Here are some key aspects for providers to keep in mind:

  • Under the new rules, CMS would increase the Medicare Outpatient Prospective Payment System (OPPS) by 2.7 percent in 2020, increasing total payments to OPPS providers by a collective $6 billion.
  • In terms of price transparency, hospitals would be required to publish all “standard charges” in electronic format, as well as 70 common procedures defined by CMS. Failure to comply could result in fines of up to $300 per day.
  • As for physician rates, CMS would increase the overall physician payment rates by 0.14 percent in 2020, changing the Physician Fee Schedule conversion factor to $36.09 in 2020 up from $36.04 in 2019.
  • CMS would make clinic visit payments “site-neutral” by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments. These off-campus departments would be paid at 40 percent of the OPPS rate in 2020.
  • Total hip arthroplasty would be removed from the inpatient only list, allowing the procedure to be covered by Medicare in both inpatient and outpatient settings.

Providers that will be affected by these changes in 2020 are encouraged to learn more about how the new rules will affect them in 2020. A complete copy of the proposed changes can be located in the Federal Register at


At a Glance

Some Americans Are Avoiding Healthcare Because…                          

 …They Don’t Understand How Their Insurance Works

Healthcare Organizations Struggle with Patient Billing                                         

It Is Fraught With Problems and Is Not Easy to Pull Off

Colleges and Marijuana Laws                                                 

Become Battleground in the Conflict between Federal and State

Amazon-Berkshire-JPMorgan are Testing                                                              

Their New Employee Health Plan in Six States


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