ASC Industry Awareness
ASC Ownership Stats
The latest ASC market ownership snapshot from 2017 data shows that direct physician-only ownership across all specialties sits at a very healthy 64% and that physician-hospital partnerships make up an additional 24%. Even though this spring’s state-mandated pauses on elective surgeries reduced surgery volumes and insurer consolidation and reimbursement behavior have placed some downward pressure on ASCs, the current consumer-driven nature of healthcare and governmental concerns to keep healthcare costs at bay will produce long-term windfall for ASCs. For detailed ownership data, see here.
ASCs Overcoming 2020 Challenges
ASCs have been effected dramatically by elective surgery postponements in the spring and summer coupled with extensions given to insurers, which have resulted in delayed reimbursements. Many ASCs and related groups have lost significant revenue and some expect revenue losses of 20-30%. Staffing is another challenge for 2020. Nearly a quarter of ASC leaders see increased turnover of registered nurses and 63% have found it harder to recruit operating room nurses. However, the future looks great for ASCs because they are nimble, add value to the healthcare system, and because patients are still concerned about going to hospitals for elective procedures. In another sign of ASC health, 22 ASCs opened or announced their opening in August.
Healthcare Industry Trends
Despite Hospital Layoffs and Closures, Hospitals May Have Averted Disaster
Hospitals and health care systems have experienced a composite $323B in losses, 42 hospitals have filed for bankruptcy, and 15 have closed outright so far this year (19 closed in 2019). A Moody’s financial analysis, however, states that due to a combination of increased healthcare utilization rates, higher acuity patients returning for treatment, cost containment efforts, and financial relief from the CARES Act, hospitals have avoided their Q2 worst-case scenario.
Ongoing Payment for Telehealth
As telehealth gained massive wind beneath its sails over the past six months, the outstanding questions have been surrounding issues of payment. The federal government has forced insurers to pay adequately to support care during the pandemic. Would anyone pay, though, when the heat and spotlights are off? CMS is stepping up, expanding both the reimbursements and the types of services it will cover. In May, BCBS of Tennessee was the first commercial insurer to make their COVID-19 telehealth coverage permanent. The White House is supporting telehealth innovation by asking insurers to sign a pledge to expand long-term telehealth benefits, which is receiving a very positive response. HHS is also focusing on telehealth as a vital part of the tech innovations they want to employ in their Rural Action Plan strategy, since rural areas are been hard hit by long-term hospital closures.
Healthcare Digital Transformation Watch
Telehealth and Then Some
Telehealth is working beyond their wildest dreams at Chicago’s Rush University Medical Center, now that they are overcoming technical barriers that kept their telehealth services at bay over the last five years. However, telehealth isn’t the only area of healthcare digital transformation making news. HIPAA is now under pressure since health information is increasingly digital and protecting privacy becomes increasingly difficult and necessary. Healthcare platforms are also becoming plentiful and their advancements are likely to drive distance between winners and losers in healthcare.
Out-of-Network Watch
Some Wins for Providers
Over the summer, the state of Indiana is adopting its new surprise billing requirements. Out-of-network providers are still able to bill out-of-network charges if they obtain the patient’s consent. In a new survey, 60% of Michiganders delivered a clear consensus on who should bear the financial responsibility when patients receive surprise out-of-network medical bills. Their consensus? Insurance companies should pay the tab. In Surgery Ctr., P.A. v. Aetna Life Ins. Co., the Third Circuit court dealt with an out-of-network breach of payment issue. The decision for the surgery center is an important one for out-of-network providers as it demonstrates that courts will not allow insurers to use the anti-assignment clause as a reason to underpay medical providers.
Legal
Proposed Medicare Reimbursement Reductions
From the office of Jon Sistare, JD, Attorney at Law
Part of our legal team’s review is to keep an eye out on the federal government’s legislative agenda. Just recently, the Trump administration proposed to reduce reimbursements to Medicare providers in the next federal budget cycle. President Trump’s 2021 budget proposes about $500 billion in net Medicare spending reductions over ten years, most of which would come from reducing payments to health care providers and would not affect beneficiaries directly.
Physician groups are speaking out against slashes made to reimbursements in the Centers for Medicare & Medicaid Services’ proposed 2021 Physician Fee Schedule. The new rule will result in these significant reductions in Medicare payments if the current draft takes effect on Jan. 1:
| 9% for cardiac surgery | 8% for thoracic surgery | 8% for anesthesiology |
| 7% for vascular, general, and neurosurgery | 6% for ophthalmic surgery | 5% for orthopedic surgery |
The Surgical Care Coalition says, “… the cuts were even harsher than expected, dealing an extra blow to the many surgeons whose businesses took major hits when elective surgeries were banned earlier this year.” It further states, “The policy was ill-informed and dangerous to patients even before the pandemic started, but could be even more detrimental as our healthcare system continues to weaken under COVID-19. This rule will likely force surgeons to take fewer Medicare patients, leading to longer wait times and reduced access to care for older Americans.”
At a Glance
In 2021, Newsweek Is Planning to Rank the Best ASCs
Plans to Rank the 400 Best ASCs in 25 States
Cigna/Anthem Merger Falls Apart
Neither Can Collect Damages over Who Sabotaged the Merger
Who Should Pay for Mandated Covid-19 Workplace Testing?
Not All Small Business Health Insurers Will Pay
U.S. Regional Healthcare Cost Interactive Maps
Compare Regional Healthcare Use and Cost Data
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