February 14, 2020

ASC Industry Awareness

ASCs Celebrating 50 Years by Growing Stronger

As the ASC industry turns 50 this year, market forces are propelling significant growth, as ASCs become a more central feature of US healthcare. Approximately 5,800 Medicare-certified ASCs are serving patients across the United States with gastro, eye, ortho/spine, podiatry, and pain centers being most prominent. Once unthinkable, cardiac procedures are now making their way to outpatient surgery venues. Physicians or physician groups own the majority of ASCs, while the largest six ASC management companies hold a nearly 19% market share. ASCs are not evenly concentrated across the country, however. Nearly 93% are located in urban or suburban areas. Regional conditions make some states more amenable to ASC growth. See why the Texas ASC market, for example, is booming.

2020 ASC Reimbursement Rules and Trends

CMS finalized its 2020 payment rule this past November. ASC leaders appreciate the rule, since it recognizes patient migration to ASCs. ASCs receive an effective update of 2.6 percent on Medicare covered procedures and 8 new codes made the ASC-payable list, including total knee arthroplasties. Total hip arthroplasties and six spine codes were removed from the inpatient only list. CMS continues to include more and more complex surgical procedures for Medicare patients in ASCs, which will likely press any private insurers that may be on the fence about providing coverage to follow suit.


Healthcare Industry Trends

HHS Interoperability Rule Kerfuffle

Technology has made patient record interoperability feasible. But what is actionable in the real world as we know it today? A year ago, HHS proposed rules to improve the interoperability of electronic health information that built upon nearly a decade’s-worth of efforts. Part of the effort is to stem information blocking that keeps records out of patient’s hands. 2020 CMS interoperability milestones are nearly upon us and that raises angst and pressure. The EHR system giant, Epic, took the lead in opposing the current structure of the interoperability rule and has pulled 66 healthcare systems along for the ride over concerns that interoperability isn’t safely actionable with the number of healthcare apps that would be engaged. HHS Secretary, Alex Azar, and CMS Administrator, Seema Verma, have both blasted Epic for using scare tactics. Healthcare IT companies are divided on the information blocking rule.

Rural Hospitals Hard Pressed

Rural hospitals have endured a decade of challenged fortunes in the United States. Low patient volume, heavy reliance on government payers, and the shift to outpatient care have all hit rural hospitals hard. 124 rural hospitals have closed since 2010. A record 18 rural hospitals closed in 2019. Rural hospitals have closed in 31 different states. This is not an insignificant issue. Mortality rates are generally higher in rural areas, and people tend to be older, poorer, and sicker.


Revenue Cycle

Patient Financial Experience Is Part of the Medical Experience

The patient financial experience can no longer be safely divorced from the entire healthcare experience. Patients and their employers have sufficient responsibility for medical payments that they care about the quality of their entire experience. This awareness has been slower to dawn on much of the healthcare provider community but an effort to redesign patient billing is acknowledgement of the change. Increasingly, the financial consequences of care are viewed in tandem with the clinical consequences of care, because both influence patients’ well-being and access to care.


Healthcare Digital Transformation Watch

EHR in the News beyond Interoperability

Due to the HHS interoperability proposal, EHR companies and systems are an area of intense focus in the healthcare IT world. Even with Epic’s role in pushing against HHS’s current proposal, it continues to hold the top spot in the KLAS annual IT awards for overall software suites. Epic, Cerner, Allscripts, Athenahealth, and Meditech have become huge businesses nationally and internationally, in large part owning to their power of medical records storage and the potential that interoperability promises. That does not mean these businesses are without significant problems. The VA is delaying its Cerner EHR rollout due to the lack of development of interfaces between Cerner’s EHR, the existing VA EHR, and the VA’s IT infrastructure. The problem of physician frustration with electronic health records shows no signs of remediation.



Prosecutions and Pill Mills: A Look at the Department of Justice’s 2019-2020 Trends

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

2019 was a big year for the U.S. Department of Justice (DOJ), which recovered a staggering $5.04 billion dollars in unnecessary and fraudulent claims. The opioid crisis has resulted in top-level executives being held personally accountable for their actions, as were the companies they serve. Insys Therapeutics was fined $2 million and forced to forfeit over $200 million in revenue generated by their high dose fentanyl spray, which was the subject of a company-wide kickback scheme.  Reckitt Benckiser Group agreed to fork over $1.4 billion to settle allegations it unlawfully marketed the drug Suboxone, a commonly abused street drug. New technology is being keenly monitored as well; the DOJ recovered $2.1 billion in fraudulent genetic testing claims billed to Medicare in 2019.

Based upon the increase of recovered funds and the aggressiveness of the DOJ when it comes to prosecuting fraud and abuse, it is clear that 2020 will experience further scrutiny on providers dealing with opioid narcotics. As Virginia Attorney General Mark Herring put it, “We will not allow anyone to put profits over people, or to exacerbate or exploit the opioid crisis for their own benefit.” While other illegal activities such as kickback schemes and providing treatment that is not medically necessary was addressed by the DOJ, targeting opioid related criminal activity will remain their prime concern for much of 2020.


At a Glance

What Can Healthcare Learn from Theme Parks?
How to Create Immersive, Transformative Patient Experiences

Worry about Affording Healthcare in Retirement?
JAMA Survey Links Fear to Avoidance of Healthcare Services

Inventive Mixed-Use Senior Living Medical Spaces
Mixed Use Senior/Medical Spaces a Growing Trend               

Employer/Employee Health Insurance Costs Still Rising
Costs Force Some to Get More Creative

U.S. Life Expectancy Rate Rises for First Time in Four Years
Fewer Drug Overdoses Play a Role                         

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