ASC/OBS Industry Awareness
Robotics-Assisted Technology in ASCs
ASCs provide high volume, lower-cost procedures: passing safety, quality care, and reduced cost onto their patients. Cost/benefit calculations have kept robotic-assisted technology from wide use in ASCs. However, with the advent of lower operating cost robotics-assisted technology, ASC adoption is increasing. Even as ASC leaders see the promise in robotics, they are conscientious in balancing the initial cost of robotics technology against patient outcomes for the types of procedures they undertake. Measuring the cost effectiveness of robotic systems is a valuable exercise since system costs and capabilities vary significantly as can patient satisfaction and clinical outcomes.
ASCs/OBSs Continue to Improve Healthcare
The US public has awakened to the immense benefits that ASCs and OBSs provide to our healthcare system. Cost-effective care, safer clinical outcomes, and streamlined patient service models have all been drivers that have enabled ASCs and OBSs to take their rightful place in US healthcare. In a first of its kind study, The Nationwide Ambulatory Surgery Sample database was used to obtain national ASC safety data from 2016-2018 to determine ASC safety for a variety of procedures. While the analysis showed that mortality rates varied significantly depending upon procedure type, relative ASC safety is a clear outcome of the data study.
Healthcare Industry/Trends
Primary Care Turnover a Health and Financial Concern
Medical personnel were often already hard pressed, but two years of dealing with COVID-19 has exacerbated healthcare staff burnout and raised attendant problems for individuals and for the system. The American Medical Association (AMA) led a study on healthcare expenditures attributable to primary care physician (PCP) burnout and turnover with pre-pandemic 2017-2018 data. The AMA analysis found that PCP turnover leads to nearly $1B in annual US health care costs. Continuity of care is one of the most dramatic losses borne by patients. Based on data obtained, the study estimates that over 11,000 PCPs will leave their current practices each year – 3,000 of them due to burnout.
At Insurance Contracting Time Impasses Are Plentiful
It is not uncommon to see several insurance and provider contracting struggles of national note this time of year, however, the size of the issue seems to be growing annually. Ft. Lauderdale, FL-based Broward Health’s contract with UnitedHealthcare (UHC) will end April 1 unless the two sides come to an agreement. UVM (University of Vermont) Health Network is citing UHC approval delays experienced by its patients as a rationale for not renewing their UHC contract while UHC decries UVM’s price acceleration. Blue Cross Blue Shield of TX (BCBSTX) shifted negotiation tactics with the large Memorial Hermann Hospital in Houston by contracting with individual physicians but not with Memorial Hermann. The two sides have just reached a deal to renew their months-long standoff.
Healthcare Digital Transformation Watch
Tremendous Patient Interest in Telehealth Prompts Potential Expansion
Healthcare IT is growing in 2022 following adaptations during the pandemic. Among the healthcare IT trends to watch for further development this year are the digital front door for patients, further expansion of telehealth, predictive analytics, medical image analysis software, and AI-powered healthcare operations. Of these, telehealth has the most immediacy to affect patient care with 73% of patients in a recent survey saying they want to receive some or all of their care virtually. Recent McKinsey insights show that telehealth use has now grown by 38x from the pre-COVID-19 baseline. The AMA is continuing to press federal and state governments to keep patients connected to telehealth. On February 7, two US Senators introduced the bipartisan Telehealth Extension and Evaluation Act, which would extend telehealth waivers for two years beyond the end of the public health emergency. In response, Amazon is expanding its telehealth program.
Healthcare M&A, Valuation, Revenue Cycle
Too Expansive?
The Department of Justice (DOJ) had until February 27 to choose whether to block the Change Healthcare and UnitedHealth Group planned merger. The merger would combine two large entities expert in data analytics, technology, and healthcare services. On February 24, the DOJ sued to block UHC’s $13B acquisition of Change Healthcare. The rationale is a critical one. If UHC owns Change Healthcare, it will have access to its health insurance rivals’ competitive information for its own uses. In other activity, FlumeHealth, a digital plan administrator landed $30 million in a funding round primarily from Optum and Cigna. Stryker completed its $3.1 billion acquisition of Vocera Communications. Tenet has chosen not to spin off Conifer as a revenue cycle subsidiary.
Legal
Federal Court Strikes Down QPA as Sole Determinant of IDR in the NSA
On September 30, 2021, HHS and the Departments of Labor and the Treasury issued implementing regulations for the No Surprises Act, stipulating that the qualifying payment amount (the plan’s median in-network rate in a region) is the default payment in the independent dispute resolution (IDR) process. On February 23, 2022, a federal court struck down those implementing regulations, replacing them with the broader mechanisms for resolving disputes that were stipulated in the original IDR section of the Act. This is a huge win for healthcare providers, a rare ruling against HHS that keeps this kind over-reaching activity in check, and an excellent outcome to help maintain a fair and balanced system.
At a Glance
AMA’s Effort to Fix Prior Authorization
Sign the Congressional Petition for Access to Timely Treatment Here
Medical Claims Expected to Grow in These Areas in 2022
Joint Pain, Diabetes, Obesity, Hypertension, Cardiac, and Spine
Anthem Rebranding to Elevance to Widen Offerings
Signaling Company’s Expansion beyond Insurance
Amazon’s Alexa Now Working as a Healthcare Extension
Enables More Patient/Provider Engagement
Which Rural Hospitals Are at Risk of Closing?
Center for Healthcare Quality & Payment Reform Fact Sheet
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