ASC/OBS Industry Awareness
2022: A Very Busy Year for ASCs and OBSs
All indicators point to a busy 2022 for ASCs and OBSs: commercial insurers pushing more subscribers to ASCs , 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 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 ASCs/OBSs in 2022 is when they will able to return to pre-pandemic stability – which seems to be largely dependent upon patient perception and adequate staffing.
OBSs and ASCs Drive Benefits for Patients, Independent Surgeons, and System
Outpatient procedures have grown to the extent over the past several years that ASC surgeons generally believe this is an accelerating trend, particularly in bone and joint surgery. OBSs and ASCs are an incredible value in the US healthcare system and now, after a couple of pandemic years, the country is alert to that fact. Of course, business interests are also aware of this reality, so hospitals and private equity groups are developing new partnerships and centers too. Even though it receives less press, independent centers are finding success in bringing on young physician investors. Bone and joint surgeons remain among the most independent surgery center owners in the US ASC/OBS market.
Healthcare Industry/Trends
Pandemic Pressures the Patient Experience
Healthcare providers have long known that the patient experience starts before the appointment and continues through the end of treatment and payment for services. are patient payment responsibilities, expectation-raising technologies, and a pandemic that is driving 75% of healthcare facilities to seek temporary staff. Providers are no longer just competing with other providers, but also with pharmacies and retail health clinics. Patients are seeking high-quality medical advice and safe, frictionless experiences that give them control over their health, which standard medical professionals are still in the best position to provide. Providers investing in their patient experiences will reap the benefits.
Public Health State of Emergency Status
The American Hospital Association is urging the Federal Government to renew COVID-19 emergency declarations that are set to expire January 16. The current federal public health emergency declaration was issued in October of 2021. Several states, including Maryland, Delaware, Kansas, Virginia, and New Jersey, have released their own state of emergency declarations in January. All indications are that the federal government will renew its COVID-19 emergency declarations, particularly since a continuance of declarations will be necessary for its new COVID testing insurance payment policy, beginning January 15.
Healthcare Digital Transformation Watch
Telehealth: 2022 and Beyond
Telehealth is likely to go through a transformation in 2022. The American Medical Association is pushing the US Congress to make ongoing provision for telehealth as a component of regular healthcare delivery, not just during a national healthcare emergency. Legislators have already floated legislation to extend COVID-19 telehealth emergency waivers for two years to give some time for telehealth’s transition. As it is, the practice of telehealth does have some issues to work out, such as adding to patient demand and taxing medical providers. Near-term advances in patient monitoring and reimbursement need to be forthcoming in 2022 to make telemedicine stick. Interestingly, new technology developments, like LG televisions that come equipped with a telehealth platform, are helping to advance the cause.
Legal
Eight 2022 Health Priorities to Watch
From the office of Jon Sistare, JD, Attorney at Law
Eight health policy priorities to keep your eyes on in the coming year:
- COVID-19 Public Health Emergency (PHE)/Telehealth: As the pandemic wears on, the healthcare industry has found itself in an unprecedented state of flux. The U.S. Department of Health and Human Services (HHS) extended the federal public health emergency (PHE) through Jan. 13, 2022, and various states have their PHEs with differing end dates. By law, the federal PHE cannot be extended for more than 90 days at a time. It is expected that an additional 90-day renewal will be announced soon, with an expectation for further extensions until at least mid-2022. The PHE declaration gives HHS the authority to provide blanket waivers and Section 1135 waivers relating to otherwise applicable requirements under Medicare, Medicaid, the Health Insurance Portability and Accountability Act (HIPAA), Physician Self-Referral (Stark) and other laws. During the PHE, providers have entered into arrangements and set up care delivery systems that depend on these.
- Provider Relief Fund (PRF): Congress appropriated a total of $178 billion to HHS to distribute to healthcare providers who incurred COVID-19-related response costs and economic losses. After several distributions during the Trump Administration, the Biden Administration is now making its first allocation (the so-called “Phase IV” funding) under a formula that provides greater relief to small providers and those with high Medicaid caseloads. As of this writing, there are approximately $20 billion to $26 billion of unallocated funds in the PRF.
- Health Equity/Improving Data Collection: Equity in health outcomes continues to be a top priority for the Biden Administration and Congress, driven in part by overwhelming evidence of how the pandemic has disproportionately affected historically marginalized and low-income groups.
- Surprise Billing Implementation: HHS released a new rule implementing the No Surprises Act dictating that the median contracted in-network rate, known as the “qualifying payment amount” (QPA) in a geographic area, would be presumed to be the correct payment rate for an out-of-network provider absent credible evidence demonstrating that the correct rate is “materially different” from the QPA.
- Medicare Payment Reductions: Last month, Congress passed a bill that mitigated looming cuts that collectively threatened to reduce Medicare Part B payments for many providers by nearly 10 percent.
- Public Health Legislation: Only a short time after the onset of COVID-19 in February/March 2020, discussions began on Capitol Hill regarding how to shore up the nation’s public health system to respond better to future pandemics. Significant funding has been poured into federal, state and local public health agencies as part of the various COVID-19 relief bills passed by Congress.
- Cures 2.0: In November, Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) introduced the highly anticipated Cures 2.0 Act (H.R. 6000). Among other things, this bipartisan bill contains provisions to accelerate medical research, increase patient access to novel therapeutics, remove current barriers to telehealth services, and codify a modified version of a recent rulemaking that would accelerate Medicare coverage of breakthrough devices.
- Market Consolidation: Vertical and horizontal consolidation in numerous segments of the healthcare industry continues to draw federal attention. This trend includes market participants diversifying into different niches – for example, insurers acquiring physician practices and other providers or pharmacy benefit managers acquiring pharmacies and drug manufacturers.
At a Glance
Health and Fitness Trackers Getting More Granular
Too Early to Know Whether This is really a Helpful Development
December Cyberattack on Maryland Department of Health
Problems Still Persisting over One Month Later
State Reactions to Pandemic Are Changing Populations
Five Net Population Winners and Five Net Population Losers
Congratulations Univ. of Maryland Cardiology Department
First Genetically Modified Pig Heart Transplant
Employers’ Health Insurance Costs Surged in 2021Due to Resuming Electives throughout Bulk of the Year
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