ASC Industry Awareness
2019: A Year of ASC Expansion
As healthcare alignments reshuffle, it is now apparent that systemic realignment is coalescing around ambulatory surgery centers as high quality, lower-cost alternatives for outpatient surgeries. Over 200 new ASCs opened or announced plans to open in the last 12 months. Independent physician groups, hospital joint ventures, private equity, and ASC management companies are all figuring into the growth. If you are curious about which states are experiencing the highest ASC growth rates, click here. On January 6 in greater Memphis, TN, Campbell Clinic unveiled a $49 million surgery center expansion, indicative of the kinds of efforts physician groups are developing in response to their growing markets.
Growth in ASC Total Joint Programs
ASCs have been adding total joint programs to their array of surgical services at a growing pace. This list of 12 ASCs that developed total joint programs in 2019 demonstrates that growth is not only with knee arthroplasties. CMS 2020 rules enable ASCs to perform Medicare patients’ total knees surgeries. If you’re thinking about adding a total joint program, these considerations and tips from Dr. Brian Schwartz may come in handy. We are all thrilled to see the growth in ASCs, but even growth sometimes surfaces issues. Provider shortages are projected in the United States over the next 10 years. If such shortages take place, ASCs would need to make adjustments.
Healthcare Industry Trends
Key Issues for 2020 from the American Medical Association (AMA)
Clearly, individuals will not find full agreement on each of the six issues the AMA has slated as key for 2020. Nevertheless, the AMA is the largest association of physicians (both MDs and DOs) as well as medical students in the United States, so it is highly influential. Two of those issues are likely to be most engaging for ASC personnel. The AMA is weighing in on the push to prevent surprise billing by arguing for an arbitration process that builds on New York’s success. The second AMA push that ASC leaders will find most interesting is the campaign to fix prior authorization. The AMA is correct that the physicians’ determination of medical necessity along with patient plan coverage should be enough. Their effort has been significant in moving the U.S. Congress to address the issue in the Medicare program. H.R. 3107, Improving Seniors’ Timely Access to Care Act of 2019, is the bill to curtail Medicare’s prior authorization so patients obtain care that is more efficient.
2019 Healthcare Tech Headline Toppers
Remote patient monitoring technology that helps increasing numbers of providers track high-risk patients has been, and will be, a headline topper. Closely related are telehealth reimbursement and CPT codes, which are expanding, but are still in early stage developments. Similarly, state-level telehealth legislation is moving in fits and starts. MHealth (mobile and wireless technologies supporting health objectives) is increasingly being used to enhance care management for both people with substance dependencies and for those with multiple chronic conditions.
Healthcare Digital Transformation Watch
Dr. Google: Healthcare Partner or Existential Threat?
In 2019, Google sent out former CEO, Eric Schmidt, to pitch health-data company, Cerner Corp., on using Google as data storage provider for their 250 million health records. Cerner could not obtain detailed data use assurances it wanted from Google, so the deal fell through. Google also sought a data relationship with Epic, the EHR software company, which also has more than 250 million patient records. Epic chose to walk away, though Google locked in a relationship with Ascension and several other healthcare companies. Google is pitching the potential for better care for patients through use of personally identifiable patient data. Healthcare companies are skittish, wondering if Google is really a partner or if it poses a threat to their business or even to patient privacy. Catch the story in this WSJ podcast.
Legal
A Touchdown for Providers in Federal Court
by Sean Laffey, Contego Legal Analyst, from the office Jon Sistare, JD, Contego Attorney
On January 2, 2020, U.S. District Judge, Joe Fish, ruled that Cigna could not use attorney-client privilege as an excuse to avoid handing over plan documents to participants. The suit, Advanced Physicians S.C. v. Connecticut General Life Insurance company et al., was brought by a medical provider on behalf of former NFL players, arguing the defendants improperly denied clams and refused to provide supporting documents to the claimants. The United States District Court for the Northern District of Texas decided that plan participants were the true “clients” of ERISA and therefore have a right to access these plan documents.
Historically, plans have been very protective and secretive regarding privileged material such as internal communications, payment schedules, and internal policies. Now the road is paved for plan participants to have access to these materials in the interest of enforcing their rights under their plan. This also means that providers with a properly executed assignment of benefits can stand in the plan participants’ shoes by demanding equal access to such materials.
The courts also noted that, “an assignment to a healthcare provider facilitates rather than hampers the employee’s receipt of health benefits.” This means courts are more likely to support assignment of benefits to satisfy ERISA’s command to provide benefits exclusively for plan participants. Cases like this are important in that they increase the level of transparency between the consumer and their purchased product, especially in an industry, such as healthcare, where matters tend to be extremely opaque.
At a Glance
Nonprofit Hospitals in Tug-of-War with Insurers
In the Effort to Contain Costs
First At-Home On-Demand Medical Exam Kit Launches
Patients Can Stay Home to Have Doctors Listen to Their Hearts
Medicare Panel May Seek 2021 Pay Freeze
Commission’s Proposal Would Affect Doctors and Surgery Centers
In Minnesota, Allina Partners with Optum
Planning to Build Surgery Centers to Lower Healthcare Cost
Hospital Outpatient Visits Are Down Year-to-Year
First Year-to-Year Decline in 35 Years
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