March 16, 2020

ASC Industry Awareness

American Awareness of ASCs on the Rise

A now ubiquitous supplemental coverage insurer rose from obscurity by employing a talking duck. ASCs however, are rising in the American consciousness without the aid of a mascot. When outpatient surgery centers become a topic of reporting in publications like US News & World Report, there is clearly some wind behind the sails. ASCs have become a staple in the current healthcare world due to safety, cost-effectiveness, convenience to patients, and the benefits they provide to the entire healthcare system. Due to these factors and more, ASC practitioners are increasingly positive about the future growth of ASCs.

Comprehensive Care for Joint Replacement Model (CJR Model) Extension

On February 20, 2020, CMS issued a proposed rule in the Federal Register to extend the CJR Model for three years through 2023. The rule proposes changes to the definition of a CJR episode that would include outpatient hip and knee replacements along with updates to claims data that form the basis of Medicare payments. In early March, the American Association of Orthopaedic Surgeons (AAOS) released a statement welcoming CMS’ incorporation of knee and hip replacements in this three-year extension. The AAOS also expressed opposition to the target price adjustment, which uses only the most recent year of claims data, because it is likely to hamper financial performance.


Healthcare Industry Trends

HHS Finalizes Historic Interoperability Rules

Health and Human Services (HHS) has finalized its interoperability rules to provide patients more control of their health data. The new rules let patients download health records to their phones. While the new rules ease patient access to records, not all access will be HIPAA-protected. The rules go into effect for federal health plans beginning January 2021. Tech companies have largely welcomed the new interoperability rules, but many healthcare providers are taking a more cautious stance out of concern for potential patient data abuse. Interested in the key dates in the process timeline to date? Want to know the key dates of the process timeline moving forward?

Hospitals Adjusting to New Landscape

Caring for coronavirus patients is an immediate and hopefully short-term adjustment for hospitals. However, outmigration of cardiac care is one of several ongoing shifts to which hospitals are responding. Due to rising costs, the lack of patients, and insufficient reimbursements to cover costs, several hospitals have taken significant actions to address their shortages. Mayo Clinic is closing a hospital and some clinics in Minnesota. Community Health Systems is selling hospitals and converting others to emergency-only operations. A West Virginia hospital is closing and laying off 600 employees after trying unsuccessfully for one year to find a buyer. Tampa General Hospital staff are taking a pay cut to offset costs and the hospital is bringing back house calls.


Revenue Cycle

Revenue Cycle a Growing Part of Healthcare Business

Whether a surgery center performs all of its own claims and revenue cycle processes or outsources some or all of that function, revenue cycle in healthcare is receiving increased notice in our era of challenging reimbursements and expanding patient financial responsibility. Successful revenue generation, capture, and collection activities drive financial health for surgery centers. Maximizing reimbursements in ASCs is essential to financial health but sometimes is deterred by the challenges of the claims and appeals process. For this reason and others, global healthcare revenue cycle services and medical billing outsourcing are growing significantly.


Healthcare Digital Transformation Watch

Healthcare Tech Making News

Even though the enclosed coronavirus stats from late February are already out of date, the fact is still inforce – healthcare tech is making a real difference in helping to tackle the novel coronavirus. Responses to coronavirus include teeing up telemedicine, which will move advances in that area forward more quickly. In a development that happened more quickly than most assumed, Amazon’s Alexa is now using drug databank information to answer clinical drug questions. Google’s Project Nightingale; which gathers patient information to create software that makes suggestions about treatment plans; is still controversial, but is gathering interest and clients. Strategies for optimizing interoperability are proliferating.



Supreme Court Agrees to Hear Arguments Regarding the Individual Mandate

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

Earlier this month, the Supreme Court agreed to hear arguments from state attorneys general concerning the enforceability of the individual mandate under the Patient Protection Affordable Care Act (PPACA). If the individual mandate is found to be unconstitutional and unalienable from the rest of the act, it could have a significant impact on  our country’s healthcare system. For example, employer based plans would no longer have to offer insurance to full-time employees and their families. Other consumer protections such as essential health benefits could also evaporate depending on the Supreme Court’s decision.

Opponents of the argument claim that striking down the PPACA would leave many workers without insurance and damage working families that already struggle to afford healthcare. As Attorney Brian Hufford puts it: [The PPACA is] designed to protect patients. If you throw out all the PPACA, there’s going to be a huge void and an incredibly complicated process of figuring out what’s been eliminated, what rights have been lost and how we can get those back.” However, the Supreme Court is not set to hear arguments until sometime this fall; for now the American people will just have to wait and see.


At a Glance

Medigap V. Medicare Advantage
What Is the Difference?

Delaware’s New Healthcare Opportunity
Challenging Its Costly CON Laws

Woman Gets Mauled by a Bear but…
Says Worst Part Was Dealing with Her Insurance Company

The Top 1% of Users…
Account for 22% of Total Healthcare Spending

Violinist Plays in the Operating Room
While Surgeons Operate to Remove Her Brain Tumor

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