October 15, 2021

ASC Industry Awareness

The Shift Is On

Our national responses to Covid-19 have solidified the position of ASCs in the minds of Americans over the past 18 months. The shift to ASCs is on – and that is a story worth celebrating! Safety, availability, and convenience have been on patients’ minds. However, there is a lot more to the story. Shifting common outpatient procedures to ASCs could save as much as 59% for commercially insured patients. The new popularity of ASCs means that physicians and owners are more regularly looking into technologies, including robotics, which could make them even more competitive. Twenty-three new ASCs started in September – some founded by independent groups, others by hospitals, and some jointly. Building is not the only way to grow. The shift continues through many creative expansions as seen in these seven ASCs.

Every Good Change Requires Some Hurdle Leaping

Even with tailwinds, ASCs have to overcome some obstacles to get to their most desired destinations. Rapidly changing government directives such as the number of CMS-approved procedures, reimbursement parity between ASCs and HOPDs, and the CMS 2022 proposed rates are on ASC leaders’ minds. Certificate of Need states continue to provide barriers to entry for useful and needed ASCs, as is the situation with this Alabama heart ASC. As in most of healthcare, ASCs have concerns with staffing. Vaccination mandates appear to be a mixed bag for ASCs, which are experiencing some staffing issues but expect to be able to offer staff a better quality of work life than larger hospitals. The impending physician shortage looks to be the longer-term staffing issue since younger doctors are not primed to replace retiring ASC physicians.


Healthcare Industry/Trends

Healthcare Staffing: Meeting Future Need

Healthcare staffing has been in the news lately, primarily for the suspension of unvaccinated employees and secondarily for the 18% quitting and the 12% being laid off during the pandemic. The pandemic has exacerbated US healthcare staffing trends like the projection that Florida will have a 60,000-nurse shortfall by 2035. Some hospitals are weathering the pandemic fairly well, but others are consolidating efforts or laying off workers. Healthcare employs about 1 in 8 Americans. Continuing healthcare staffing shortages are expected, but there are some bright spots in healthcare education with nursing school enrollment growing by 6% in 2020.

Pandemic Raising Questions about Certificates of Need (CoN)

In the US, we now have 40 years’ experience with CoN laws. Thirty-five states and Washington DC currently prohibit expansion of healthcare facilities through CoN laws. During the Covid-19 pandemic, at least twenty states suspended aspects of their CoN laws. Enacted in 1974, CoN laws became ubiquitous across the nation in the 1980s. The intended goal of CoN laws is to reduce healthcare costs and increase quality and access to care. However, CoN laws shield groups from healthy competition in many ways, often decreasing access to care and increasing costs. CoN laws were used earlier this month to strike down a proposed surgery center in North Carolina, a state that recently had a partial CoN law suspension.


Healthcare Digital Transformation Watch

Healthcare Data Breaches on the Rise

In March of this year, over 1,000,000,000 CVS Health records, including patient emails, were found on an exposed database. This turned out to be a case of accidental data exposure and CVS took the proper steps to avert harm. This situation renewed calls for healthcare to be increasingly vigilant about the risks of data breaches – whatever the cause. Data breaches in healthcare are $2M more costly per event than in other industries since breaches often affect such large populations. Multiple healthcare organizations have suffered data breaches due to cyberattacks since the CVS breach. Healthcare data breaches are on a steady rise since the beginning of statistics keeping on this issue twelve years ago. The rise is continuing in 2021 with an average of 58.8 breaches affecting 3.7M records  – each month!



Price Transparency Issues – Make Sure You Are in Compliance!

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

On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposal that would significantly increase the fines that would be imposed on hospitals for price transparency violations. This proposal, included in the “2022 Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System Proposed Rule,” aims to promote competition. The proposal is, in part, a response to complaints and reports that hospitals are not in compliance with the new CMS price transparency rules that became effective January 1, 2021. These CMS price transparency rules require all hospitals operating within the United States to publish the public cash prices and payor-negotiated rates for the services they provide, when available. The requirements do not apply to independent ambulatory surgery centers or physicians not directly employed by a hospital, but if the ASC or the physicians are employees of a hospital, the rule applies.

As it stands, the maximum fine for violation of the CMS price transparency rules is $300 per day, or $109,500 per year. This federal proposal would dramatically increase this maximum penalty to as much as $5,500 per day, or over $2 million per year, for a Medicare-enrolled hospital. If a hospital does not provide CMS with this documentation, that hospital would be penalized at the highest rate permitted. If finalized, these increases would become effective on January 1, 2022. Hospitals seeking to avoid substantial fines should begin taking steps to comply with these CMS transparency rules prior to that effective date.


At a Glance

2022 Medicare Physician Fee Schedule Analysis 
Currently Offers a Significant Reduction from Last Year

A Brief History of The Affordable Care Act
Just the Dates and Facts

Major Insurers Running Billions Behind on Provider Reimbursements
Providers Taking Notice

256 Hospitals Warned by CMS
Large Percentages of Hospitals Remaining in Violation of Price Transparency Rule

Over 500 Rural Hospitals at Risk of Closure
1/4 of Rural Hospitals at Immediate Risk


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