ASC Industry Awareness
Physician-Owners Are Opening New Surgery Centers in 2021
Noise in every category of news making nearly invariably focuses on the biggest, the fastest, or the newest-looking trend. We understand the noise in in 2021 ASC growth has been around consolidation, hospital/management companies, and private equity investments. However, independent physician and physician group owners are actively pursuing growth opportunities. Phoenix Spine & Joint opened its third and largest surgery center to date in Gilbert, AZ. Irvine, CA is the site of the new Orange County Surgical Center, a comprehensive physician-owned outpatient vascular surgical center. Two orthopaedists in greater Louisville, KY left their hospital positions to start a new practice and surgery center venture in Jeffersonville, IN, in part to reduce the cost of care in their region. Yet to come in 2021 will be a new physician-owned spinal center in Lakeland, FL.
The World of ASC Trends
Surgeries have been moving toward ASCs for some time, but the trend for many specialties is now accelerating. Situations with hospitals during the pandemic forced some surgeries to go outpatient and even though surgeons may have preferred using hospitals, they found success. The trend toward outpatient surgeries is caused, in part, by the increasing direct marketing to patients, who bear ever more financial responsibility for their healthcare choices. Inflationary pressures over the next few years will also force ASC leaders to analyze and manage their supplier costs. Not all ASC trends are perceived universally as positive, however. Some ASC leaders are concerned about the push for robotics in joint replacement, bundled payments, and the rate at which higher acuity surgeries are moving to surgery centers.
Healthcare Industry/Trends
Retailing Healthcare
The retail healthcare movement is picking up steam all over the country in places both expected and unexpected. Telehealth has sped this shift, but retail companies sense they are truly part of an “omni-channel solution,” enabling people to afford care rather than to defer it. We expect Walmart to be full in, and they are, the latest of their efforts being basic spine and chiropractic care, which they are piloting in five Tennessee locations. A more surprising entry is Dollar General, which is moving into healthcare products for rural customers across its’ 17,000 stores.
Executive Order Promotes Healthcare Competition
On July 9, the Biden Administration released an executive order promoting competition in the American economy. See the fact sheet here. The executive order seeks to stimulate competition across industries, particularly among those where large organizations dominate. Competition in the healthcare marketplace is one of the focus areas of the executive order and could have a positive impact on ASCs. The executive order also seeks to limit noncompete orders for employees.
Healthcare Digital Transformation Watch
Digital Twin Technology: Analogues, Doppelgangers, Dead Ringers?
The full force of digital twin technology is yet future, but the promise of it is drawing nearer – likely along with attendant foreseen and unforeseen problems. The digital twin is a virtual copy of a tangible object or an intangible system that can be analyzed to help make informed decisions regarding its’ real-world mate. The big promise of digital twin technology in healthcare is the growth of personalized medicine. Check out how digital twin technology can help healthcare operational performance and patient satisfaction in this Siemens Healthineers whitepaper. Capture a hint of the myriad applications of digital twin technology here.
Legal
Updates from Washington on Health Care Issues
From the office of Jon Sistare, JD, Attorney at Law
Two important events took place within the past month in Washington.
- On June 17, 2021, the Supreme Court upheld the provisions of Obamacare. This was the third challenge of the all-encompassing law to get to the Supreme Court, and each time the Court has upheld the law. Even with a conservative majority on the Court, the ruling was 7-2 in favor. The only dissenting votes were Justices Alito and Gorsuch.
- While the ruling was based more on technical grounds against the parties that brought the case to the Court (the State of Texas and 17 other states), most Court pundits believe this is the last challenge to the law, which has caused so much political discussion since its inception in 2011. The technical ruling was based upon whether the State of Texas and the other 17 states had standing to sue… the Court did not find that the states had been harmed by the law, thus, they had no standing to bring the case.
- Even before the ruling, the Biden Administration made efforts to expand the law. Part of the pandemic economic recovery acts have included money to help those who have lost jobs to pay their health insurance premiums under Obamacare. Many, who were not signed up prior to this, have now enrolled in Obamacare. Thus, it is unlikely the law will see any efforts to remove it from the books with so many people now using it as their primary health insurance coverage.
- Just before the July 4th weekend, the Departments of Labor, HHS, and Treasury released the first of the interim final rules on the new federal No Surprise Medical Billing law. As you may recall, this was signed into law at the end of President Trump’s administration and had a bipartisan effort behind it. The law will not take effect until January 1, 2022, but the departments that oversee it, Labor, HHS, and Treasury, were tasked with promulgating the rules under which it will operate in advance of that date.
- A word to the wise is that every medical provider should become aware of the provisions of the law and how it might affect them, especially those who practice as out-of-network (OON) providers. One of the most important aspects of the law is called the Qualifying Payment Amount (QPA). Briefly defined, it is used for two purposes: (1) To determine cost-sharing requirements for patients if an all-payer model or specified state law does not apply; and (2) To be one factor considered by the arbitrator during the independent review process to determine the total payment for OON services. The law defines the QPA as the median of the contracted rates paid by the plan on January 31, 2019 (and increased for inflation annually thereafter at the CPI-Urban rate), for the same or similar service that is provided by a provider in the same or similar specialty and provided in a geographic region in which the service is furnished.
- That already is a lot to digest and understand, and it is just one aspect of the law. There is more to come on this law, and more to understand. There is not likely enough space in this column to give it a fair explanation. But, as stated previously, any medical provider who may be affected by this law – either to the good or the bad – should make themselves aware of it and its intricate meaning. There are opportunities for OON practitioners to protect themselves from underpayments by the patient’s insurance company.
At a Glance
UHC Emergency Room Post-Care Denial Policy Proves Unpopular
Policy Could Have Chilling Effect on Patient Protection
Supreme Court Leaves Affordable Care Act Intact
Rejects Challenge to Act in a 7-2 Decision
Hospitals Not Complying with Transparency Rule
83% of Hospitals in Noncompliance with at Least One Requirement
Even Recreational Marijuana becomes Legal in Several States
States Using Legislative Processes Rather than Ballots
Hospitals Return to Net Job Losses in June
After Enjoying Only One Month of Net Job Gains
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