ASC Industry Awareness
Hospitals Aware of Growing ASC Dominance
For those who have been in the ASC industry a while, it comes as a bit of a surprise to see hospitals asking questions like, “Can Your Hospital Survive the Growing ASC Dominance?” Overnight admission surgeries are now approximately only 20% of the procedure market. ASCs are more nimble, more efficient, cheaper, and safer for most inpatient surgeries. On the expense side, a recent UnitedHealth Group report noted that ASCs are 59% cheaper on average than hospital outpatient departments for a variety of common procedures. Hospitals are taking notice and action – though some of those actions are sometimes fraught with challenges. Grady Hospital in Atlanta has run headlong into one of those challenges – a huge $13.6 million cost overrun in building their new surgery center. Private Practice/Hospital partnerships are also working to grow new centers like this one in upstate New York. Not to be outdone, independent physician groups are also getting in on the new center action.
Biggest Current Challenges for ASCs
It seems that no matter the times, there are unknowns that keep leaders up at night. However, being a healthcare provider during a pandemic stretches the number of (and fears associated with) those unknowns. Inconsistent payer policies press providers and their staffs to spend more time and resources on revenue cycle management. Current staff shortages and impending staff shortages are causing ASCs to take a good hard look at staffing needs. The proposed CMS 2022 walk back of 298 services to the inpatient only list also has ASC leaders scratching their heads.
National Brands Gaining Comfort in Healthcare Marketplace
The pandemic has spurred several national brands not known for their healthcare offerings to expand their work in the healthcare space, growing their comfort in doing so and the publics’ comfort in their healthcare offerings. Google has learned from contract tracing that it has a greater role to play in embedding healthcare research rather than in new commercial services. Walmart, Amazon, and Kroger are cooperating with the federal government’s new effort to make at-home Covid tests more widely available. Amazon is expanding its primary care service, Amazon Care, to 20 new cities, prioritizing employers. Dollar General is adding healthcare products to reach the rural “health deserts” where the majority of its customers live.
Hospitals Having Tough Time with Price Transparency
Major healthcare system adjustments brought to bear through legal action are often challenging in terms of compliance. We will see this same scenario in the carry through of the No Surprise Act in early 2022. Hospitals are struggling to comply with the federal hospital price transparency rule that took effect January 1, 2021. A recently PatientRightsAdvocate.org report found that 94.4% of hospitals were not in compliance. Hospitals are not posting key pricing information, sometimes in part due to the difficulty of obtaining it from a variety of insurers and plans.
Healthcare Digital Transformation Watch
Growth and Risks in Healthcare IT
The promise of harnessing the power of behavioral economics, EHRs, AI, Low Code, and HiT in general is that the cost of healthcare can be reduced without compromising quality – and perhaps even enhancing it. Digital transformation has accelerated since the beginning of the pandemic in early 2020 and healthcare data, particularly data interoperability, is central to this growth. Even with the pandemic uptick, the majority of physicians still believe the healthcare industry lags in technology adoption. Adoption in areas such as AI, however, may come with ethical risks for healthcare, as demonstrated in this July World Health Organization report. However, low code development is coming to the fore in healthcare innovation as a reliable means of scaling customized software solutions.
Update on the No Surprises Act (NSA)
From the office of Jon Sistare, JD, Attorney at Law
Get used to the term NSA in the health field and industry. NSA is not the National Security Agency in this case! It stands for No Surprises Act, also known as the No Balance Billing Act. This is the act that was discussed in Congress for years to prevent balance billing by out-of-network providers to unsuspecting patients, usually in the emergency room or by air ambulances. The previous administration signed this into law in late 2020, with an effective date of January 1, 2022.
The new administration has been working to craft the rules that will allow this law to be implemented and to work in favor of patients who have been surprised to receive bills from providers for care they didn’t ever realize was “out of network.” Of particular concern are those situations when the patient is receiving emergency care at a time when most patients are not concerned about whether a provider is in or out of network.
The first draft rule was issued on July 1, 2021. The second proposed rule was issued on September 10, 2021. This latest rule is mostly about the air ambulance component of this law. Air ambulances, as emergency services, are obviously quite expensive. Many are out-of-network. Patients have received balance bills from these services in the $20,000 to $30,000 range and were naturally outraged and unable to pay. Most of the readers of this brief article are not in the air ambulance field so we will not spend any more time on it.
However, for the benefit of the readers, if you are an out-of-network provider or facility our recommendations are:
- Have someone in your practice get to know the ins and outs of the NSA. It can be an instrument to help OON providers increase their revenue stream but the law and subsequent rules are complex.
- Follow the articles in your professional literature that discuss the NSA. It takes effect on 1/1/2022, but there is one more draft rule to be issued, which may be the most important as it relates to the arbitration process which is a part of the law to help to resolve differences between payors and providers.
- Expect that the federal agencies, states, payors and everyone else involved in this matter will likely not fully understand the working mechanics of this law come 1/1/2022 and that our experiences with it may be like driving a car down a bumpy road on bad shocks. It will not be a pretty ride but we will all get to a better place on OON billing soon … we hope!
Our belief is the NSA will offer more benefits for OON providers than any other legislation in recent memory. Get to know it and be prepared to take advantage of what it has to offer.
At a Glance
Updated Interactive Covid-19 Maps
Check Your State and County Vaccination and Hospitalization Rates Here
September 9, 2021 Whitehouse.gov Covid Plan Language
Six-Pronged Vaccination, Testing, Care Strategy
Vermont All Payer Model Missed Financial Goals
State Auditor Questions Healthcare Reform Implementation Costs
Medical Debt Now Outweighs All Other Personal Debt in US
Mean Medical Debt of $429 per Person
Ballad Health Reached June Deal with RIP Medical Debt
Erased $278m in Patient Medical Debt
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