December 11, 2019

ASC Industry Awareness

Total Joint Programs Growing

As of January 1, 2018, CMS policy shifted to enable total knee arthroplasty surgeries to be performed in outpatient settings. Over 250 ASCs now have total joint surgery programs and many more will soon develop. Practical literature is developing that will assist new ASCs to create their own total joint surgery programs, which can be a big boost for serving patients and for ASC’s continued business. These pieces range from professional association newsletter tips to interviews with independent surgery center administrators who have established programs to white papers that provide more details on the process of developing outpatient total joint programs.

Issues on ASC Leaders’ Minds Going into 2020

2019 has been an excellent year in many ways for the growth of ASCs: more varied surgeries are commonly moving to outpatient settings, the number of surgeries performed in ASCs is rising, as are the number of outpatient surgery centers. Growth is wonderful, but it has not induced a change in sleep patterns for most ASC leaders. With growth comes other challenges, like staffing, which is a significant issue for many ASCs. Hospitals are now looking for opportunities to offset lost revenue and are actively pursuing surgery centers in that effort. The challenge of obtaining appropriate reimbursements remains a stubborn reality for many headed into the New Year. Contego is meeting that reimbursement challenge with increasing depth for our clients headed into 2020.


Healthcare Industry Trends

Healthcare Changes Drawing Lawsuits

In November, the Trump Administration announced hospital price transparency rules that are drawing immediate legal threats. Under this latest rule, hospitals and insurers would be required to reveal rates. Multiple hospital associations are preparing for a court battle over transparency, believing that the federal government is overstepping its authority, but CMS is ready for the legal challenge. Hospital groups are also concerned that current price transparency efforts will chill necessary competition in the healthcare marketplace. This is not the only large legal action in healthcare. Anthem plans to sue the federal government $100 million for unpaid risk corridor payments. More hospitals are suing patients for payments to recover costs. Hundreds of hospitals are banning together to sue HHS for cutting Medicare reimbursements.

What Is Happening with Health Insurers?

2019 has been a good financial year for the vast majority of large insurers, with revenues growing significantly year over year as of the end of Q3. UHC reports 2019 revenues of $245B and expects to hit $260B in 2020. The federation of 36 BCBS companies is launching a national provider network for employers to start in 2021. The major stated goal of the program is to help large employers in 55 US markets reduce medical costs. The state of California is flagging and fining Anthem Blue Cross significantly more than other healthcare insurers. For enforcement actions and penalties, see here.


Healthcare Digital Transformation Watch

New Collaborations Create Some Disquiet

The big news in healthcare IT collaborations is Ascension Health and Google’s data effort, dubbed “Project Nightingale.” The speed of technological change now confronting healthcare is overwhelming the regulatory framework set up to protect our health information, causing many to wonder just how safe our health data actually is. Smaller healthcare and IT company collaborations are less known publicly, but will still have the ability to rock the health data safety boat. Cerner and Amazon are teaming up on AI and machine learning for interoperability. Athenahealth is collaborating with BirdEye to bring patient experience data into EHRs. Facebook has added a new feature that allows users to find area physicians and set appointment reminders. These and a host of other recent tech collaborations are creating data and privacy unease.



American Hospital Association (AHA) v. Azar

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

A coalition of groups, headed by the American Hospital Association, is challenging a Trump administration rule regarding the public disclosure of pricing information. The lawsuit, American Hospital Association et al. v. Azar, alleges that the new rule is “unlawful, several times over”. (Alex Azar is the Secretary of the Department of Health and Human Services).

The rule would require hospitals to publish lists of charges for standard procedures, including procedures as identified by CMS. The plaintiffs argue several points, the first being that the rule conflicts with the Affordable Care Act. The ACA only requires hospitals to disclose “standard charges,” and the AHA claims that confidential pricing information does not fall into the category of standard charges. Next, AHA asserts the costs associated with compliance would cause financial distress for hospitals already running at a low or even negative margin. Finally, the case states that the new rule is unconstitutional, asserting that it infringes upon the right to free speech by compelling speech that does not serve a government interest.

Caitlin Oakley, a spokesperson for the Department of Health and Human Services, states that, “Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it.” This new rule follows the Trump administration’s effort to increase healthcare transparency to consumers. The president was quoted earlier in November as saying, “We believe the American people have a right to know the price of services before they go to visit the doctor.”

In either case, the result of this could have far-reaching implications for medical providers and healthcare consumers alike. The case currently resides in the U.S. District Court for the District of Columbia.


At a Glance

U.S. Life Expectancy Drops for Third Straight Year

Signals Alarming Trend with Several Known Causes

Most Executives Unaware of Proposed Interoperability Rules

Healthcare Payers Are Better Informed Than Providers

Proposed Changes to Anti-Kickback Statute Explained

Clarifies Stark Law for Value-Based Care

New Podiatry Program Airs in January

New Jersey Podiatrist Featured in, “My Feet Are Killing Me.”


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