ASC Industry Awareness
2021 ASC Industry Trends
Globally, the estimated market value of ASCs is $1.89 billion as the industry continues to grow at a 6.1% annual clip. Economic realities during the pandemic are affecting trends in the ASC world. ASCs are proving their value to an increasing number of people as they provide convenient, caring service at much less cost. Unemployment for some during the pandemic will mean additional delayed procedures, many of which will come due in the last half of 2021. Consolidation in healthcare is also having an effect on ASCs, though strong independents mitigate that effect. Sixty-seven spine codes will be removed from the CMS inpatient-only list this year, enhancing the outlook for ASCs performing spine surgeries.
ASCs Gain Traction Due to Safety and Costs Savings
December UnitedHealth Group findings are a win-win for ASCs. Well over one-million hip and knee replacement surgeries are performed annually in the United States. ASCs provide a safer experience for patients undergoing joint replacement surgeries while they can reduce cost to payers by as much as $3 billion annually. This savings does not just apply to patients and commercial payers it also applies to Medicare. From 2019-2028, by moving joint replacement surgeries from HOPDs to ASCs, Medicare expects to save $73.4 billion.
Prior Authorizations in View
As much as insurers want to tell the world that they are also healthcare providers, their profit motives sometimes do not actually align with what’s best for their subscribing patients. Providers have been decrying prior authorization practices for years without gaining much traction. That seems to be changing. Ninety percent of providers have stated that prior authorization practices have gotten worse in the past few years. For many providers the issues are egregious, not only because they buffet the legal provider-patient relationship, but also because they also keep patients from accessing prescribed treatments. The AMA is leading the charge to push forward prior authorization reform initiatives and many other medical groups across the country are joining in the effort. The fact that payers are not happy with a new CMS prior authorization rule that seeks to reduce provider and patient burden may provide the first glimmer of needed reform.
Large Companies Try to Widen Their Healthcare Footprint
In 2021, Walmart plans to build upon its 2020 efforts to expand supercenter clinics and open network insurance coverage for the general public through its partner, Clover Health. Haven Healthcare, the 2018-intiated venture between JPMorgan Chase, Berkshire Hathaway, and Amazon, demonstrated the challenges inherent when large companies seek to enter and transform the US healthcare system. After just three years, Haven is no more. This failure has not dampened Amazon’s ambitions. Amazon Care is currently serving its own employees but is gearing up to run primary care for other large companies in the not too distant future.
Healthcare Digital Transformation Watch
2021: Safeguarding Telehealth Coverage and Healthcare Cybersecurity
In 2020, we witnessed the ramp up of telehealth efforts beyond what we could have ever imagined as doctors ended up dispensing both health care and tech support. The federal government encouraged telehealth adoption to cope with patients’ health care needs throughout the public health emergency. State governments are now enacting laws to safeguard telehealth coverage. Massachusetts is working toward permanent rate parity and New York wants to expand access to everyone in the state. However, Harvard researchers warn that cybersecurity challenges are increasing with the relaxation of rules around virtual care. Healthcare cyberattacks are spiking wildly, increasing 45% since November.
Initiatives to Expect Under a Biden Administration
From the office of Jon Sistare, JD, Attorney at Law
Clearly, the new Biden Administration’s position on the ACA will be to keep it, strengthen it and expand it. With Democrats in control of the Senate, the only potential roadblock would be the Supreme Court’s decision on the ACA, which is still pending.
Other Biden proposals might include the creation of a public health insurance option through the ACA Marketplace that would aim to reverse the increase in uninsured and underinsured Americans over the last four years.
However, a combination of more modest plans could produce a similar effect, such as lowering the Medicare eligibility age from 65 to 60, offering plans in states that did not expand Medicaid, and expanding subsidies. If Medicaid eligibility is extended to all Americans age 60 to 64, it could increase coverage for up to 20 million Americans and reduce insurance costs for employers.
In addition, the new administration is expected to focus on the socioeconomic and racial health disparities that the pandemic has highlighted. Biden has promised to establish a COVID-19 Racial and Ethnic Disparities Task Force, which will then turn into a permanent Infectious Disease Racial Disparities Task Force.
Other initiatives may include efforts to make paid sick, family, medical leave a federal requirement. Additional topics may include work on health care nondiscrimination, short-term insurance, and association health plans.
With regard to the recently passed provider transparency rules, there may be challenges to that law, but analysts expect it to survive and stay in place.
In sum, the best way to view the incoming Biden administration’s position on health care issues is as stated in a Price Waterhouse report, “In many ways, President-elect Joe Biden is proposing a return to the Obama administration’s approach to healthcare. However, healthcare executives cannot simply dust off their Obama-era playbooks. Biden will assume the presidency in a country that is very different than it was in 2009, when he became President Barack Obama’s vice president.”
At a Glance
Envision Dropped from UnitedHealth’s Network
UHC Blames Envisions’ High Prices in Dropping 25,000 Clinicians
The Coronavirus Is Mutating
Video Presentation on What Is Now Known
Hospitals Now Have to Publicly List Cost of Care
But They Don’t Have to List Everything
Concern over the Patient Experience Grows
As Healthcare Organizations Recognize It as a Key to Their Growth
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Contego Solutions, LLC