This is a phenomenal time to be an ASC owner. Opportunities abound because of disruptive changes that are transforming the ASC market. In fact, the past several months have seen unprecedented changes in regulations and laws that impact ASC’s. Here are three legal and regulatory changes that will affect ASC’s:
- CMS Reimbursement: CMS has moved 267, mostly musculoskeletal-related services from the inpatient-only list to outpatient, with the entire inpatient surgical procedure list being phased out by 2024. This is great news for all ASC’s. The opportunity to grow surgical volume and provide services to a wider range of patients has never been better.
- Stark Law Modification: The Stark Law was changed to promote the development of Accountable Care Organizations. This change should make it faster and less expensive to develop these agreements and provide physicians and payors greater flexibility. This rule change provides an opportunity for leaders and owners of ASC’s to create patient centric agreements that provide optimal patient value for surgical services.
- No Surprises Act Passage: This act was passed in response to a trend of so-called “surprise billings” by Out of Network providers for Emergency services and scheduled in-network services provided by Out of Network physicians. It is not completely clear how the new Federal law will be deployed as several states have passed their own version of No Surprise billing laws. These laws may present a challenge for hospitals and ASC’s in how best to communicate to patients what their financial responsibilities may be beyond what their insurance covers for a surgical procedure.
In addition to the legal and regulatory changes, the pandemic has changed patient preferences as people needing surgery increasing look to ASC’s because of safety concerns about hospitals. While some of these changes may create an additional regulatory compliance and reporting burden, the changes also provide ASC’s with a unique opportunity for accelerated surgical volume growth. Simply put, they drive more surgical volume from hospitals and HOPD’s to ASC’s. You can expect commercial payors to become increasingly proactive in incentivizing patients to receive their surgical care from ASC’s. Seizing this opportunity requires greater efficiency and consideration of capacity expansion through acquisitions, or other means. This will continue the momentum toward ASC chain acquisitions and hospital partnerships over the next few years. If partnerships or acquisitions are an option for your center, defining a plan to expand your services lines will position your center for an optimal financial outcome.
The final step will be sustaining the growth once achieved. So, ASC’s need to plan for the necessary IT, analytics, and capacity growth investments that will enable greater patient centricity and ongoing scalability. For example, it has never been easier to adopt IT technology for an Electronic Medical Record. Having a surgical scheduling system, a billing solution with an EMR that also supports PAT and anesthesia documentation will be an important expansion and capital investment to have in place to meet regulatory, quality and operational reporting. Developing an assessment of your ownership’s risk / reward tolerance will be important in choosing expansion, capital investments, optimal services lines and supporting technologies, such as IT. Now is the time to develop a strategic plan for the growth of your ASC to take full advantage of the positive regulatory and payor developments!