ASC Industry Awareness
This past month has produced a flurry of data on ASCs, some meaningful, some perhaps not so much. We will report and let you decide which is which. Thirteen ASCs opened or announced their opening last month. Newsweek ran their 2021 400 Best ASCs report. Amazingly, at least 525 ASCs are offering total joint replacement surgeries. Surgical robots are in the news at a variety of surgery centers across the country. Sixty-two surgery centers across the US were also awarded the 2020 APEX quality award for demonstrating center excellence in patient satisfaction and care.
ASC Physician Ownership Still Rock Solid in an Era of Consolidation Noise
Independent ASC physician owners paying attention to their business markets will notice the fanfare surrounding healthcare consolidations, mergers, partnerships, and private equity investments. Hospitals looking to curtail pandemic losses through ASC ownership, insurance pressure on smaller groups, and finding younger surgeon-owners are all challenges for independent physician owners. 64% of ASC owners are physicians and that model is still rock solid. Recently, the big consolidation push is due to the thinking that scale alone will ensure success, which is not necessarily the case. Working with groups like Contego will also help independent owners optimize reimbursements and mitigate risk. Even with the current consolidation clamor, more spine surgeons are becoming directly involved in ASC ownership.
Commercial Insurers’ Expansion Plans
Responses to the Covid-19 epidemic in the United States in 2020 created a unique situation for providers and insurers. Largely, insurers were able to delay payouts while their premium income continued unabated. This created the ability to plan expansions and the largest of our country’s 900 health insurance companies have done so. Cigna plans to expand its commercial footprint by 25% and wants to reach 50% of the Medicare market in the next few years. UHC/Optum is planning to add 10,000 primary care physicians to its organization this year. Humana is planning to open 100 Medicare centers in lower-served areas by 2023. Aetna plans to reenter the ACA individual health insurance marketplace in 2022.
Early Price Transparency Compliance Is a Bit Random
Hospitals and healthcare systems are taking a scattershot approach to price transparency in their aim to comply with the new price transparency rule, which began January 1 and applies to 300 shoppable services. The government granted hospitals wide discretion in how they format price data, with the goal of making that data relatively easy to find. Some hospitals offer downloadable data, others a web page, still others have yet to publish their price information. Turquoise Health has made the task a lot easier by creating a cost comparator tool that contains price information from 6,000 providers nationwide. This is just the first round of many in the broader federal effort to create medical pricing transparency.
Healthcare Digital Transformation Watch
First reported on March 5, the Microsoft cybersecurity breach that allowed hackers to access the email accounts of over 30,000 US organizations is only the most known in this surge. Healthcare organizations have been particularly vulnerable. In the past few months, a New Mexico hospital was extorted via large-scale ransomware, an Arizona eye clinic had 100,000 patient records exposed, a Virginia health plan incurred a data breach that affected 34,000, a Washington-based pediatric clinic and urgent care company experienced a ransomware attack that exposed the personal data of over 200,000 patients, and a Texas home-based healthcare provider had over 100,000 of its patient records breached.
New Covid Relief Bill Includes Significant Funding for Health-Related Issues
From the office of Jon Sistare, JD, Attorney at Law
As we know, President Biden just signed the new American Rescue Plan (ARP), a massive bill that is meant to get to all sectors of our society assistance as we continue to fight the impact of the pandemic. Here’s a quick summary on the parts of the new law that health care providers should know:
- PUBLIC HEALTH FUNDING
Like previous COVID-19 relief packages, this bill includes funding for COVID-19 vaccine distribution, testing and contact tracing, and support for healthcare workforce expansion and public health initiatives.The bill also provides support for workforce initiatives, including $7.66 billion to state, local and territorial public health departments to hire staff and procure equipment, technology, and other supplies to support public health efforts. The legislation includes $100 million for the Medical Reserve Corps, $800 million for the National Health Service Corps, $200 million for the Nurse Corps, and $330 million for teaching health centers that operate graduate medical education.The bill allocates $47.8 billion to continue implementation of an evidence-based national COVID-19 testing strategy, and directs $1.75 billion to support genomic sequencing and surveillance initiatives.
- PROVIDER RELIEF LOOK-A-LIKE FUND FOR RURAL PROVIDERS
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed in March 2020, established the Provider Relief Fund (PRF) to reimburse providers for COVID-19-related expenses and lost revenues. To date, $178 billion has been appropriated to the fund. Approximately $153 billion has been allocated to providers, and about $25 billion remains to be allocated. This $25 billion does not account for PRF distributions that have been or may yet be returned to the US Department of Health and Human Services (HHS) by recipients that rejected the financial support, so the actual amount remaining could be larger. The remaining funds are subject to spending limitations for providers for the second half of 2020 and the first quarter of 2021 due to provisions in the appropriations bill passed at the end of 2020.
- FUNDING FOR MENTAL HEALTH AND SUBSTANCE USE DISORDERS
Mental health remains a serious concern during the COVID-19 pandemic. Studies have shown increases in suicide, opioid addiction and other mental health crises. The bill allocates $3 billion for block grants to state and local government entities to address mental health and substance use disorders, as well as additional funding for behavioral health workforce education and community-based behavioral health services.
- RURAL HEALTHCARE GRANTS
The COVID-19 pandemic has financially affected rural providers in particular. While a portion of the pandemic relief fund was allocated specifically to providers in rural areas, many believe more support is needed.
HHS and Congress provided waivers and flexibilities related to telehealth services during the pandemic. These have allowed a significant expansion of telehealth use, increasing access for patients and giving providers additional means to ensure continuity of care while the pandemic limits in-person visits. These flexibilities have also allowed providers to use new, innovative ways to treat patients with mental and behavioral health issues, as well as chronic conditions such as diabetes and hypertension.Stakeholders have emphasized the importance of maintaining these flexibilities beyond the pandemic. The waivers are tied to the authority provided through the Public Health Emergency (PHE), however. In order to stay effective, the PHE must be renewed by HHS every 90 days. While the current PHE declaration runs through April 20, 2021, the Biden Administration has indicated that it likely will extend the PHE through the end of 2021. Stakeholders are hopeful that Congress will make permanent some of the telehealth waivers before the end of the year.
- PAYMENT FOR PHYSICIAN SERVICES
The Consolidated Appropriations Act, 2021, directed Medicare to make a 3.75% positive adjustment to calendar year 2021 physician payments, which was applied to the Medicare physician conversion factor. This provision helped mitigate (but not eliminate) scheduled payment cuts to Medicare physician services for calendar year 2021. The Medicare physician fee schedule is a budget-neutral payment system, and these payment cuts were largely driven by increased spending for office/outpatient evaluation and management services, typically delivered by primary care providers and certain specialty physicians.The 3.75% payment boost was authorized for only one year, which means that physicians will again face reductions in 2022 unless Congress acts. The ARP does not include a fix for this impending payment cut, but stakeholders are urging Congress to act before the end of 2021.
All providers should investigate and be knowledgeable about what provisions within this new law can provide financial support due to the impact of the pandemic on their practice and employees.
At a Glance
Inside the Pandemic Plastic Surgery Boom
What’s Driving People to Get Plastic Surgery Now?
What Would Reimbursing at Medicare Rates Mean?
Cost Savings, but at What Cost to Providers?
Is There a Silver Lining the Pandemic Has Revealed?
There May Be More than One for Healthcare’s Future
Why Haven Healthcare Failed
Changing the System Is Harder than It Appears
Western Kentucky High School Student Aiming for Ortho Surgery Career
Dreams to Work near Hometown
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Contego Solutions, LLC