ASC Industry Awareness
2021: A Boom Year for New ASCs
Ambulatory surgery centers continue to grow in popularity as centers of choice for a growing variety of procedures. 2021 has been a banner year for new ASC starts, with over 40 reported in the month of November alone. Even though independent and physician-owned ASCs are still being built, the most ink is spilled on hospital-built surgery centers. See here for a state-by-state breakdown of those. 222 new ASCs have been built or proposed in 2021, with the monthly numbers rising throughout the year. The benefits the ASC industry brings continues to vary widely by state, in large part due to regulations and CoN laws. Check out these basic ASC stats in New York and Florida as a case in point.
2022: A Busy Year for ASCs
All indicators point to a busy 2022 for ASCs: more commercially insured patients, staff shortages, insurer documentation requests, elective surgery demand, and continued explosion of opportunities in growing regions around the country will all play a part. The migration of trauma procedures to ASCs is notable even as many believe CMS has missed an excellent opportunity to reduce their costs in 2022 by removing 255 procedures from the ASC-payable list. ASC total joint replacements continue their forward momentum and are projected to grow by 95% by 2026. A big question for some ASCs in 2022 is to what degree they will able to return to pre-pandemic stability – which seems to be largely a function of patient perception.
Healthcare Industry/Trends
Retail Healthcare Moves
CVS and Microsoft are now working together to develop digital health and personalized products even as CVS works to place a greater focus on care delivery, including physicians for the first time, at several of its locations. Walgreens is all in on its plan to open primary care clinics with VillageMD in direct competition with CVS and Walmart Health Centers and Care Clinics, now open in Arkansas, Georgia, Illinois, and Texas. Dollar General is not exactly considered a mover and a shaker, but that is exactly what it intends to be as it makes forays into improving the healthcare product offerings available to underserved US rural populations. Amazon Care is moving out beyond serving its own employees, as Hilton becomes its newest client, creating access to Amazon’s app-based medical services for 2022.
Payer Obstacles
Providers are increasingly encountering private payer obstacles. As a reimbursement expert, Contego sees this dynamic at play and counters it for our clients. With the increased cost of doing ASC business, reimbursement reductions are pinching ASCs’ bottom line. This is not just an issue of competition or perception; even juries are finding insurers guilty of withholding appropriate reimbursements. Insurer profitability has remained strong throughout 2021 despite high Covid costs. CMS is also offering a 10% physician pay cut for 2022. Congress just passed a bill to avert these cuts.
Healthcare Digital Transformation Watch
Peering Into 2022: Innovation, Breaches, Big Data, Telehealth
What will be the impact of Covid-19 on next wave of health IT innovation? The pandemic has pushed us to digitize healthcare and adopt virtual care models to the degree that healthcare consumers can now increasingly expect healthcare experiences to be more like other digital market experiences while improving their healthcare outcomes. Data breaches are a huge issue for 2022 for healthcare IT. Over 500,000 people were affected by data breaches at orthopaedic practices alone in 2021. More than 40 million patient records were compromised this year. The use of big data in healthcare management is growing to affect decision-making in the evaluation of treatments and to build predictive models for local surgeons. Telehealth payment will be a topic of frequent and even heated discussion at times in the New Year. The key to its staying power is healthy payment.
Legal
An Eventful 2022 in the Offing
From the office of Jon Sistare, JD, Attorney at Law
2022 already looks to be an eventful year for the healthcare industry. Here are some things your organization can expect from the healthcare industry and in healthcare law next year.
An increase in medical malpractice litigation
The healthcare industry is bracing itself for an increase in medical malpractice lawsuits. The industry is not only anticipating an increase in claims associated with the spread, diagnosis, and treatment of COVID-19, it is also anticipating a rise in claims tied to the availability of health care and health care resources during the pandemic. Medical professional liability carriers are particularly concerned about a wave of new litigation as statutes of limitation approach in the next two years.
Increased HHS scrutiny of telehealth services
Early in the COVID-19 pandemic in 2020, the Centers for Medicare & Medicaid Services issued temporary policy changes making it easier for Medicare and Medicaid patients to receive care through telehealth services when in-person care was limited. This year, HHS’s Office of Inspector General announced investigations as part of its Work Plan that touch on telehealth services, with reports expected in 2022.
One is a telehealth-related audit of Medicare Part B Services. The audit includes two phases. The first phase focuses on whether services such as evaluation and management, opioid-use disorder, end-stage renal disease, and psychotherapy meet Medicare requirements, while the second phase focuses on a broader range of Medicare Part B telehealth services.
HHS also announced that it planned to audit home health services provided as telehealth during the COVID-19 public health emergency. The office is evaluating home health services provided by agencies to determine which types of skilled services were furnished via telehealth and whether those services were administered and billed according to Medicare requirements. OIG said it would report any improperly billed services as overpayments and make recommendations to CMS based on the results of the audit.
The results of Medicare payment audits
Going into 2022, healthcare organizations can expect a continued interest from the HHS OIG in rooting out Medicare fraud. In 2021, HHS said it will audit whether Medicare appropriately paid claims under Medicare Part B for physician services based on correct place-of-service code when a beneficiary was an inpatient at a skilled nursing facility or hospital. This audit was prompted by preliminary 2018 and 2019 data that showed that Medicare may have paid a significant number of claims at a higher non-facility rate when the beneficiary was a Part A inpatient at a hospital or skilled nursing facility.
Happy Holidays!
At a Glance
Most Physicians’ Incomes Dip When Hospitals Buy Practices
Costs Rise, but Physicians Do not Get Share of the Wealth
Medicare Spending on Ortho Surgery Plunged in 2020
$587 Million Drop Due, in Part, to Pandemic
More Americans Expected to Enroll in PPACA Plans
Plans More Attractive as Costs Drop and Benefits Increase
Five Insurers Tagged by OIG in 2021
OIG Goes after Insurers for Big Coding and Reimbursement Errors
An All-in-One Look at Healthcare Transparency Requirements
Transparency Has Been Difficult and Elusive
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