June 15, 2022

ASC/OBS Industry Awareness

Growing Outpatient Volume Creates Opportunities

ASC growth continues its upward climb, fueled by cost efficiencies, surgery shifts from inpatient to outpatient, and patient awareness. The forecast is mostly sunny for ASC patient volume nationwide. Outpatient volume is expected to grow 16% over the next ten years. At least 19 groups announced or opened new ASCs across the country in May. Texas is among ASC industry hot spots with significant developments in 2022. Independent ASCs, which for all the noise about consolidation still make up 60% of the ASC market, have some real competitive edges. Physician-owner autonomy to develop a true team environment in the operation room aids quality, safety, and patient satisfaction. ASCs and MSOs (management service organizations) present some of the brightest opportunities for growth in orthopaedics.

Opportunities Realized after Leaping Hurdles

ASCs are reaping opportunities now after facing decades of challenges to their existence. Success tomorrow requires leaping today’s hurdles. State Certificate of Need (CoN) rules sometimes form those challenges early on for ASCs. These three cases demonstrate an ASC moving forward despite opposition, an ASC whose plans were halted, and an ASC whose opposition backed down. Boosting productivity and patient satisfaction is a challenge with solutions, as this ASC discovered. Like many other healthcare organizations, ASCs are expecting staffing issues for the foreseeable future, even as new physicians become more aware of various paths they can take. ASCs are not immune to the wider economy and are battling the rising cost of everything. Five ASC leaders provide their responses here to which hurdles they believe ASCs must vault today in order to win their markets tomorrow.


Healthcare Industry/Trends

Spate of Violence in Healthcare Settings

In June of 2022, everyone knows the tragedy Milwaukee, Buffalo, and Uvalde have in common. However, as a nation, we are nearly completely unaware of the calamity that Sumter, Tulsa, Dayton, and Encino have just experienced. We would have liked to report on other stories in the healthcare world this month, but this is too glaring not to acknowledge. On May 27, officers brought a patient to a Sumter, SC hospital for a court-ordered evaluation. She balked at the order and tried to leave the hospital. When encountered by hospital security she lashed out. The hospital security officer has since died. On June 1, a disgruntled patient targeted a Tulsa, OK spine surgeon, taking four lives before taking his own. That same day in Dayton, OH, an inmate under treatment killed a hospital security guard before turning on himself. On June 3, a patient stabbed an Encino, CA doctor and two nurses, leaving them in critical condition. It is a regrettable and lamentable state of affairs that the people who have set the course of their lives to care for patients have experienced violence at their hands instead.


Healthcare Digital Transformation Watch

Creative Expansion in Telemedicine

Pandemic changes in behavior got the telemedicine ball rolling downhill and picking up steam. Now we are seeing the creative expansion of those telemedicine offerings. Can telemedicine be an answer to healthcare staffing shortages? In a partial answer, some clinicians have pivoted to full-time virtual and hybrid care. Even some segments of care that most would have thought impervious to telehealth as a delivery system are adjusting. For example, virtual physical therapy appears to be improving patient function and satisfaction after total knee arthroplasties. Nontraditional providers in the form of national insurers are getting in on the virtual physical therapy action. Both UHC and Cigna have rolled out virtual PT programs for their subscribers. Tele-ICU is another creative expansion, up and running in rural Alabama through a cooperative effort from Ascension St. Vincent’s and University of Alabama-Birmingham Medicine.


Healthcare M&A, Valuation, Revenue Cycle

PE Turns to Physicians after Courting ASCs for Years

ASCs have been in the sights of private equity (PE) investors for years since they provide significant revenue growth opportunities. PE is slowing investments in ASCs and turning to opportunities with physicians through investment portfolios aimed at people with $1-5 million in investable assets. In other M&A news this past month, US Foot & Ankle Specialists, which is a portfolio company of NMS Capital, acquired Jersey Shore Podiatric Associates, expanding their footprint to New Jersey. Optum continues its spending spree, making four deals totaling $7.6 billion so far in 2022. HCA’s deal to buy five Utah hospitals is paused until at least December due to FTC questions about market concentration.



Telehealth to Go Back to Original HIPAA Requirement as Soon as Public Health Emergency Ends

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

Telehealth providers should prepare to comply with the HIPAA health privacy law once the federal public health emergency ends, the Department of Health and Human Services said Monday.

Healthcare providers, health plans, and healthcare clearinghouses that transmit electronic health records were previously exempt from complying with the Health Insurance Portability and Accountability Act of 1996 “in connection with the good faith provision of telehealth using non-public facing audio or video remote communication technologies” during the pandemic.

Telehealth usage exploded at the beginning of the pandemic, when many practices closed their doors and patients were hesitant to receive in-person care. HHS exercised enforcement discretion to remove barriers to telehealth care from the many patients and doctors who had never had an online appointment.

The federal public health emergency is set to last until at least mid-July. The emergency, which was originally declared in January 2020, must be renewed every 90 days. The agency said it would give states a 60-day notice before letting it expire. Because that notice was not given when the HHS renewed the declaration in May, many health industry leaders believe the emergency will remain until October.

When the public health emergency expires, many regulatory flexibilities across the industry will expire. “This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improving public confidence that covered entities are protecting the privacy and security of their health information,” HHS said.

Healthcare providers should deliver telehealth services “in private settings to the extent feasible,” according to the HHS. If they cannot find privacy, they should speak quietly and not use a speakerphone. The HIPAA Security Rule, which requires doctors to protect patients’ electronic medical information, does not apply to audio-only telehealth using a landline “because the information transmitted is not electronic,” HHS said. Smartphone apps would be covered by the rule.


At a Glance

AMA: NSA Poses a Big Challenge to Doctors and States
IDR Regulations Put Thumb on Scale in Insurers’ Favor

CMS Levies Nation’s First Fines to Atlanta’s Northside Hospital
Over $1M in Fines for Price Transparency Violations

South Carolina Law Allows Hospitals to Garnish Paychecks
In Effort to Collect Outstanding Medical Debt

Leapfrog to Launch Best ASCs and Hospitals Series of Lists
Find Info Here to Nominate for Appearance in Money.com

The New Nurse Is the New Normal
Nursing Workforce Experience Fell 20% during Pandemic

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