April 15, 2023

ASC Industry Awareness

How ASCs Are Changing Healthcare

As hospitals continue to shed service lines to concentrate on their distinct advantages, ASCs/OBSs/OBSSs/OBLs are reshaping healthcare by providing services no longer efficiently performed in hospitals. Advanced technologies, such as robotics, are flowing into ASCs at increasing levels as medical device companies realize their unique opportunities. The efficiency and convenience of ASCs are improving patient access and outcomes while decreasing costs. In the current economy, ASC leaders are employing adaptations to keep costs down. ASCs are also changing healthcare by providing physicians a way out of the frustrations of corporatized medicine by furnishing autonomy and financial opportunity.

2023 Expansions

Even though ASC ownership models have expanded over time, a significant majority are still solely physician-owned and a vast majority have physician-ownership at some level. Various models are on display in the new ASC builds in 2023. The Boulder Centre for Orthopedics and Spine is in the process of opening a new ASC this summer in nearby Broomfield, CO, a far north exurb of Denver. In Vermont, a state where ASCs are just gaining a foothold, the Vermont Medical Center filed a certificate of need application in February to build a new outpatient surgery center in Colchester. This January in Northern Utah, not-for-profit Intermountain Layton Hospital broke ground on a new ASC to create more affordable care.


Healthcare Industry/Trends

Renewed Fight over Physician-Owned Hospitals

In 2010, the Affordable Care Act (ACA) restricted expansion of physician-owned hospitals (POHs). Last December, CMS granted a Medicaid facility expansion request to a Texas-based POH, resulting in renewed jockeying for position in the POH space. In February, Senator James Lankford (R-OK) reintroduced the Patient Access to Higher Quality Health Care Act, which would remove ACA restrictions on POHs. The case for POHs is multifaceted: physicians being best positioned for delivery innovation, POHs countering the rising hospital power in labor markets, and the fact that patients rate their experience in POHs nearly seven times higher than in other hospitals. That American Hospital Association and the Federation of American Hospitals are pressing to maintain the status quo with the current ACA-based restrictions on POHs.

Hospital Recalibrations

As more procedures become viable in outpatient centers, hospitals are rethinking their offerings and their staffing. Healthcare job cuts are up 65% from Q1 2022, the bulk of those in hospitals and health systems. In Q1 of 2023, healthcare had the third-highest number of job cuts among US industries. Administrative positions are not the only positions that hospital groups are revamping. Ninety physicians and providers in Florida have been laid off due to financial trouble in one system. Executives and RNs are among the affected in a system in the Midwest. Hospitals in Washington State are warning that economic realities could affect their services. In the past three months, six hospitals closed across the nation.


Healthcare Digital Transformation Watch

Digital Health in the News

It seems like everything in the digital health world is on a growth spurt. Over the next six years, the global healthcare analytics market is expected to grow at 22% CAGR. Telehealth use grew in January … for the third straight month. Use is growing so much that even casual, short, telephone calls may be subject to billing, as the sum total of them is overwhelming some providers. Attendant challenges are growing also and healthcare leaders recently had the opportunity to lay out healthcare cybersecurity difficulties in a senate committee hearing. AI is on everyone’s mind these days as healthcare leaders are seeking to determine appropriate and wise uses in healthcare.


Healthcare M&A, Valuation, Revenue Cycle

Pharmacies, Health Record Providers, and Bank Failures

On March 29, CVS completed its acquisition of Signify Health, which as a technology and at-home services company has a network for 10,000 clinicians in all 50 states. Signify will continue to deliver home healthcare, but now as a “payor-agnostic” business of CVS Health. Their near-term focus will be on Medicare Advantage customers. Mark Cuban Cost Plus Drug Company is offering its first brand name pharma product through a partnership with IBSA Pharma, a Swiss pharmaceutical company. Health record provider, Elation, added medical biller, Lightning MD, and is making big strides toward becoming the first all-in-one technology solution for primary care practices. Unsurprisingly, VC execs believe the March bank failures will slow innovation in healthcare, causing a risk-averse industry to double down on their aversion.


Out-of-Network Watch

Payments and Battles Resume

CMS is now allowing certified entities to resume all No Surprises Act (NSA) payment determinations after a pause in February, following a federal court decision in Texas that declared the NSA’s Independent Dispute Review (IDR) active process unfairly tilted in favor of insurers. Application of the original intention of the IDR portion of the 2020 law, most which went into effect in 2022, continues to be contentious. Emergency medicine claims are a very particular source of pain, when it comes to IDR effectiveness. According to the Emergency Department Practice Management Association, 68% of filed IDR claims in 2022 did not receive timely replies. See here for a comprehensive overview of NSA IDR activity and this legislative battle for fair reimbursements.



Obligations under the Family and Medical Leave Act

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

The stress in the healthcare industry has never been higher, due mostly to the past three years of the Covid-19 pandemic.  Maintenance of one’s mental health is as important as physical health, in the healthcare industry as well as the general population.  Nearly 1 in 20 adults in the US experience a serious mental illness every year, according to recent data from the National Alliance on Mental Illness. As a result, healthcare employers should take time to understand their legal obligations related to leave requests, including under the Family and Medical Leave Act (FMLA).

The FMLA only covers mental health conditions that rise to the level of a serious health condition. This includes inpatient care in a hospital, hospice, or residential medical care facility, or continuing treatment by a healthcare provider that prevents the employee from performing the functions of their position. Any mental health condition, including depression and anxiety, has the potential to qualify as a serious mental health condition. Workplace stress could even rise to this level under certain circumstances.

However, a diagnosis alone is not enough to trigger an employer’s obligations. Many mental health conditions are on a spectrum, with variations ranging in severity. Whether an employee’s condition qualifies for FMLA leave needs to be determined on a case-by-case basis.

An employee should apprise their employer of the specifics of their mental health condition in a way that makes it reasonably plain that the condition is serious, and tell their employer this reason for their absence.

However, employees must do more than simply state that they have a mental illness for an employer to be considered “on notice” of a serious mental health condition. Generally, an employee must provide details about the mental condition, including its severity and any incapacity that may occur.

Where an employee has a drastic and noticeable change in behavior or mood, an employer may be considered “on notice” without this disclosure.

On the other hand, an employer already “on notice” of a serious mental health condition, such as because an employee has previously taken leave to obtain treatment, then an employee may simply inform the employer that they need leave for that same mental illness, even if the employee does not spell out the severity for each leave request.

If an employee requests FMLA leave for a serious mental health condition, the same obligations are triggered as with any other serious health condition, including employer notice and designation obligations.


At a Glance

How Cigna Saves Millions of Dollars
Reviewing Doctors Auto-Reject Batched Claims in Bulk  

The Changing Face of Primary Care
As Seen in Village Medical at Walgreens

Primary Care Varies Broadly among States
More Patients Turning to Physician Assistants and Nurse Practitioners

Teenage Imposter Poses as Traveling Physician Assistant
For a Month Gains Wide Access to Two Hospitals

Will Telemedicine become the New Default?
An Open Question as More Treatments Can be Done Virtually


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