ASC/OBS Industry Awareness
ASC Market Positioned for an Enduring Boom
Ambulatory Surgery Centers and Office-Based Surgery Centers of various types are on a growth spurt that shows no sign of ebbing. More efficiency, better access, lower cost, and a hyper-focused patient experience compared with larger healthcare facilities are all driving more patients to surgery centers. Higher physician control in how procedures are carried out is also playing a significant role in the projected growth, since working within hospital systems increasingly means stricter treatment demands and less physician latitude. Insurers are now increasingly lining up, even favoring ASCs in some cases, in part due to the cost differential between surgery centers and hospitals. ASC’s specialization makes them a particularly good bet for thriving in inflationary times.
Surgery Center Growth Sparks Unique Opportunities
Surgery centers deliver patient-centric experiences that continue to mitigate cost, drive more patients to their convenient centers, and so create further opportunities for surgery center growth. More patients create more opportunity to grow centers and with that can come opportunities to invest in healthcare real estate. The US is seeing unique surgery center real estate popping up in states that enable that growth. Riverfront Surgery Center is now an anchor tenant in a new medical building in the growing and touristy Chattanooga, TN riverfront. In Kissimmee, FL, an ASC and lab are taking shape out of a former movie theater.
Healthcare Industry/Trends
Pressure Ratcheting Up on Prior Authorization Abuse
In a third-party payer system, most realize that some system of checks and balances are necessary, however, the frequently long waits for insurance prior approvals are frustrating doctors and harming some patients awaiting medically necessary treatments. In 2018, top medical and health insurance associations formed a consensus statement to improve the prior authorization process. Now four years later, the AMA has criticized the health insurance industry for failing to deliver on those five key prior authorization reforms. Better Medical Alliance, a Medicare Advantage advocate, also added its endorsement to the prior authorization reform effort by backing the Improving Seniors’ Timely Access to Care Act of 2021 bill. The pressure campaign is starting to have some limited affects as this month Aetna dropped their prior authorization for cataract surgeries.
CMS Releases 2023 Physician Fee Proposal
In June, the AMA endorsed and published a set of ten guiding principles for lawmakers to consider in remedying financial instabilities that are affecting physician practices. July 7, CMS responded by proposing a 4.42% physician fee cut for 2023. CMS did not have to wait their customary 60 days for comments. Clearly, another cut was not what the AMA and physicians had in mind. Catch seven physician leaders’ proposal reactions here.
Healthcare Digital Transformation Watch
Evolving the Patient-Centered Healthcare Experience
Behavioral changes produced by the pandemic forced healthcare organizations to adapt quickly to enable patients to get the care they needed. Over the past two years, providers are employing a wide variety of technologies to create more patient-centered clinical experiences. Patient portals and bedside technologies continue to develop, producing both patient care opportunities and new challenges. A Missouri ASC is making significant adaptations to quality patient care, doubling their number of patients and boosting patient satisfaction utilizing a digital care management platform. Telehealth is increasingly becoming a creative hybrid tool to deliver quality patient care in a variety of settings.
Healthcare M&A, Valuation, Revenue Cycle
Vigorous Healthcare M&A Activity
Orthopaedic device acquisitions, which waned during the heart of the pandemic, are picking up steam in 2022. Growth in orthopaedics generally is increasing private equity interest along with attendant challenges for orthopaedic surgeon owners. Revenue cycle deals were plentiful in May and June. June was also a great month for healthcare startups to complete their funding rounds. Large players in the healthcare space have not been left out of the action. USPI (ASC subsidiary of Tenet) and United Urology Group agreed to a joint venture partnership in 22 ASCs. Additionally, UHC’s Optum Health and Red Ventures partnered to launch RVO Health, a new consumer wellness platform.
Legal (Reprint from Sept. 15, 2021) – A Look Back at the Advent of the No Surprises Act
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
Exchange Denied 18% of All In-Network Claims in 2020
Healthcare.gov Lacks Clarity on Why Denial Rate Is so High
In Sign of Market Strength, UHC/Optum Cutting Some Lab Testing
Dropping “Unnecessary” Tests to Reduce Cost
Hospitals’ Revenue and Volume Bump Not Enough
Margins Are Still Weak for Many (but not all) Hospitals
Baby Giraffe at San Diego Zoo Gets Custom Leg Braces
Correction for Hyperextended Joints at Birth
Pennsylvania ASCs Experience Welcome Bureaucratic Relief
New Bill Loosens Restrictions on Outpatient Procedures
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