ASC Industry Awareness
Surgery Center Expansions
Have you ever wondered how many of the 6,300 US ASCs are in each state? Click here and wonder no more. In 2025, numerous ASCs in the works or getting their footing. A new Colorado ASC has opened its doors within a regional health ambulatory care center in the rural west central part of the state. An administrative law judge has ruled in favor of a new orthopedic ASC in the capital city of Montgomery, Alabama. At the outset of the year, UF Health celebrated groundbreaking for a new state-of-the-art orthopedic surgery center. In the northeast corner of Indiana, two health organizations are working with four physicians to expand surgical services strategically located in a shopping outlet.
ASC and Hospitals: Friends or Competitors?
Each ASC’s experience with hospitals is unique and the question of whether the two are friends or competitors in the healthcare system is specific to the particular arrangement in a given region. However, physician autonomy and ASC independence are increasingly important and valued for high-quality care in a time of significant consolidation. Seven surgeons weigh in here regarding the choice between hospital employment and independent practice/ASC ownership. Movements of surgeons run both ways … from independence to employment, due to nonclinical burdens and a tough reimbursement environment and from employment to independence, for greater decision-making autonomy.
Healthcare Industry/Trends
Healthcare Employee Deficit
Our continuing projected physician shortage is well documented. However, less rehearsed is the shortage of nursing assistants, which is projected to be the greatest US healthcare staff shortage over the next five years, with a deficit of at least 100,000. According to the US Bureau of Labor Statistics, healthcare is the industry with the highest total of projected new jobs through 2033. Leading the pack are home health and personal care aides, with a whopping 820,500 projected. Staffing shortages, an aging demographic, cost containment, and technological capabilities all play a role in that statistic as they do in the continuing push for more virtual care.
Payer Responses to Significant Challenges
Last month, the Cigna health benefits division announced its first actions to improve the experience for physicians and patients by expanding access to advocates, investing to help resolve prior authorization and post-care claims situations, and simplifying the claims submission process. Responding to online attacks, UnitedHealth Group is making significant moves to protect its online image even as groups of shareholders push it to report on the health impacts of its claim denial and delay practices. Even ACA insurers are not immune, denying 20% of claims on average. Neither is Medicare Advantage. Potential subscribers still two weeks to make adjustments – open enrollment closes on March 31.
Healthcare M&A, Valuation, Revenue Cycle
Telehealth’s Short-Term Extension
This past September we reported that the telehealth extension bill was moving forward in Congress, but the clock was ticking. Last December, Congress extended current telehealth flexibilities for two more years, through December 31, 2026. This is no small matter, given current medical staffing shortages and the ongoing need for care flexibility. According to a recent AvaSure survey, 74% of hospital leaders believe that virtual nursing will be an integral part of even acute care. To get a feel for what the future of telehealth could entail, explore the advanced telemedicine programs of Children’s Mercy Kansas City with over 54,000 total telehealth visits, EHR integration, multiple points of access, and high-quality AV networks.
Out-of-Network Watch
High Failure-to-Pay Rates
Americans for Fair Health Care, an advocacy group for providers in their surprise-billing challenges, issued a report of a survey of over 30,000 physicians. The survey found that 35% of the time insurers failed to make payment within the requisite 30 days and 22% of the time insurers completely failed to pay their No Surprises Act (NSA) Independent Dispute Resolutions. Due to the September 2024 bipartisan bill to increase penalties for late payment or nonpayment, many expect further federal government efforts to enforce compliance. Even with these issues, NSA can protect patients from surprise billing and from disputes over payment. Last month, North Carolina fined an insurer $3.4 million for violations.
Healthcare Digital Transformation Watch
Telehealth’s Short-Term Extension
This past September we reported that the telehealth extension bill was moving forward in Congress, but the clock was ticking. Last December, Congress extended current telehealth flexibilities for two more years, through December 31, 2026. This is no small matter, given current medical staffing shortages and the ongoing need for care flexibility. According to a recent AvaSure survey, 74% of hospital leaders believe that virtual nursing will be an integral part of even acute care. To get a feel for what the future of telehealth could entail, explore the advanced telemedicine programs of Children’s Mercy Kansas City with over 54,000 total telehealth visits, EHR integration, multiple points of access, and high-quality AV networks.
Legal
Update on Health Care Price Transparency
From the office of Jon Sistare, JD, Attorney at Law
In 2019, President Trump issued an executive order to improve health care price and quality transparency that led to new disclosure requirements on hospitals, health plans, and insurers. In response, HHS issued new rules that required hospitals to publicly post standard charge information and display certain services where the patient could shop around; these requirements went into effect in 2021. HHS, alongside the Departments of Labor and the Treasury, also issued new rules requiring health plans and insurers to maintain a consumer-facing tool with price information and to publicly disclose negotiated rates, allowed amounts, billed charges, and prescription drug prices.
The Biden administration revised these rules in 2021 and 2023, took enforcement action against some hospitals for failing to comply with the requirements, issued new data and tools, and increased penalties for noncompliance. Even so, it is reported that compliance has been lackluster.
To bolster these efforts, President Trump issued another executive order on February 25, 2025 directing these agencies to further implement and enforce the transparency rules within 90 days. Specifically, the agencies must require the disclosure of actual prices (rather than estimates), improve standardization to make prices comparable across hospitals, health plans, and insurers, and update enforcement policies to improve compliance. Following the executive order, HHS issued guidance affirming that federal officials are “planning a more systematic monitoring and enforcement approach” to executing the hospital transparency rule and that hospital noncompliance will be met with “swift enforcement.” This pledge notwithstanding, staffing cuts could limit the agency’s ability to aggressively enforce these requirements.
The executive order emphasizes that health plans must disclose prescription drug prices. The Biden administration had provided enforcement discretion for the rule’s prescription drug requirements through September 2023. Since then, enforcement has been addressed on a case-by-case basis. The executive order’s emphasis suggests that the agencies will take a renewed look at prescription drug price reporting.
The executive order is focused on bolstering existing hospital and insurer transparency rules. But, it also leaves room for other transparency-related policies by directing federal agencies to identify additional opportunities to empower patients with meaningful price information and to expand existing transparency requirements.
At a Glance
Physicians Sound the Alarm on Dangerous Payer Behavior
Egregious Denials, Additional Info Requests, Prior Auths
A Sad Tale Involving Isolation, Directionless, and Pain
The Education, Life, Wanderings, and Mystery of Luigi Mangione
Healthcare Insurers Are Trimming Their Workforces
13 Payers Reducing Staff Cite Contract Losses, Ops, and Finances
UHC Offered Buyouts to 30,000 (7%) of Staff
May Resort to Layoffs If Sufficient Numbers Do Not Accept Buyouts
BCBS Michigan to Charge Hospitals for Repeated Appeals
Enacting Long-Term Punitive Policy to Reinforce Denials
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