December 15, 2020

ASC Industry Awareness

Independent ASCs Headed into 2021

We have purposefully said little about Covid-19 in these monthly newsletter briefs. Providers live with that reality enough otherwise, so we have focused on other industry developments. However, we acknowledge that the pandemic has affected ASCs in unique ways in 2020 that will continue into 2021 – many of which will make ASCs stronger in the years to come. Dr. Dan Lieberman, Medical Director of Phoenix Joint & Spine, provides excellent insights into how the events of 2020 are pushing ASCs to a position of greater strength in the healthcare marketplace. In 2021, private practice physicians will have a new resource from the AMA for advocacy and networking. Congratulations on the growing awareness of the value you bring!

ASCs and Hospitals

Contego Solutions focuses on independent ASC providers and management companies. Even so, it would be ignorant for us not to acknowledge other segments of the ASC world. For the last few years, ASCs have been biting into the hospital outpatient market. Two major factors in patients’ increasing cost sensitivity are rises in high-deductible insurance and CMS’ continued expansion of ASC-payable procedures. Hospital leaders are very aware of the shift in market dynamics and realize that incorporating ASCs into their mix could be a helpful strategy in reversing their mounting fiscal dilemmas. Seventy-six hospitals and health systems have moved that way in 2020. Covid-19 has accelerated procedure movement to ASCs, adding more weight to the benefits of ASC ownership for both independents and hospitals.


Healthcare Industry/Trends

CMS’ End of Year Flurry of Activity

CMS is planning to phase out their inpatient only list by 2024, opening even more surgeries to ASCs. Catch an overview of important adjustments to the full 2,100+-page CMS physician payment rule for 2021. CMS is making some telehealth coverage permanent and is keeping other aspects afloat through the pandemic when the government can take a comprehensive look at what they believe should remain long-term. Physician-owned hospitals have been pressured by what many believed to be undue restrictions for the past decade. CMS is also seeking to rectify this by reducing restrictions on expansion.

Healthcare Policy Stories Headed into 2021

January 11, 2021 will mark a new day for transparency for patients from private-sector health insurers and self-insured health plans. The new Transparency in Coverage Rule seeks to secure price estimates on request beginning in 2023 along with several other transparency requirements. In the first significant update to the Stark law since its enactment in 1989, providers will receive more flexibility in managing patient care, which the AMA applauds. Surprise billing, Medicare Part D restructuring, drug cost reduction, price transparency, and a Covid-19 relief package are all on the docket for 2021.


Healthcare Digital Transformation Watch

2021 Expected to be Growing Year for Health IT

Even though the Health IT (HIT) advisory and consulting market took a nearly 14% hit in 2020 due to effects of the pandemic and there are aspects that will still sit on the backburner in 2021, interoperability, analytics, finance, operations, cybersecurity, and telehealth all combine to push the need for HIT consulting forward in the new year. Cyberattacks are on the rise in healthcare and are predicted to triple in 2021. Healthcare leaders are bullish on AI and telehealth for 2021 as they incorporate the lessons of 2020. Catch other digital health transformations healthcare leaders believe will be pivotal in 2021.


Out-of-Network Watch

State-by-State Balance-Billing Protections

Federally, the debate about the best way to resolve surprise medical bills is still alive – after nearly two years. Tennessee Senator, Lamar Alexander, has been working on this legislation over the past several years and will be retiring from office January 20. Now is Congress’s final chance to pass his bill while he is in office, which is unlikely. States, though, have been very active in moving legislation forward. Nine states have moved on surprise billing protections in 2020. Thirty-one states

have enacted balance-billing protections. Sixteen of those states have enacted comprehensive balance-billing protections.



Proposed New Rules for HIPAA

From the office of Jon Sistare, JD, Attorney at Law

Anyone who works regularly in the health care field in the United States is very familiar with the acronym HIPAA, the Health Insurance Portability and Accountability Act, which is a federal law enacted in 1996. The law established a national standard for the privacy and protection of personal health information (PHI).

The regulations are enforced and monitored by the US Department of Health and Human Services (DHHS). Recently, the DHHS proposed revisions to the current regulations, which are only in draft form, but soon could be enacted as part of the HIPAA regulations.

The point of the new draft regulations is to change Privacy Rule provisions “that could present barriers to coordinated care and case management — or impose other regulatory burdens without sufficiently compensating for, or offsetting, such burdens through privacy protections,” according to the preamble to the draft regulations.

Some of the provisions in the new draft regulations that could have a significant effect on commercial health insurers and other insurers would:

  • Shorten the amount of time insurers and other covered entities have to fill individuals’ record access requests to 30 days, from 60 days today.
  • Create a new “pathway” people could use to have health plans and health care providers send their records to other plans and providers.
  • Set official definitions for the terms “electronic health record” and “personal health application.”
  • Ease what individuals have to do to verify their identity when they are asking for their health information.

Some other provisions in the draft regulations would:

  • Emphasize that patients have a right to see and record their health information in person, by, for example, taking pictures of health records.
  • Make it easier for covered entities to share people’s health information for care coordination purposes and to get people help from social services agencies and community-based home care organizations.
  • Let covered entities disclose PHI when a threat to health or safety is “seriously and reasonably foreseeable,” as well as when there is a “serious and imminent” threat to health or safety.

The proposed health record pathway provision, for example, would create a new mechanism that an individual could use to share information with multiple providers.

Individuals could ask their current providers to send requests for information to other providers on the individuals’ behalf, officials write.  “This new pathway promotes disclosures to individuals’ current health care providers and health plans in a manner that retains individual control,” officials say. “The department believes that this proposal would be less burdensome than imposing mandatory disclosures for all requests for PHI for treatment, payment, and health care operations purposes.”

While the purpose of HIPAA is sound, a more streamlined effort for the release and disclosure of PHI at the request of the individual is certainly welcome.


At a Glance

Should We Blame High Healthcare Spending on Fee for Service?
Some Countries Successful with Fee for Service

Walgreens Prepares to Launch 40 Primary Care Clinics
Will Start in FL, TX, and AZ by Q3 2021

134 Rural Hospital Closures in US This Decade
American South Particularly Hard Hit

Amazon Partners with Crossover Health to Create Employee Clinics
New Clinics in TX, AZ, KY, and MI

Sand Tiger Shark Recipient of Successful Spinal Surgery in Mississippi
First Known Operation on a Shark’s Spine


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