Becker's Spine Review

39 OUTPATIENT SURGERY Biden exec order reopens ACA insurance marketplaces: What ASCs need to know By Laura Dyrda P resident Joe Biden issued an executive order to open a special enrollment period for the health insurance marketplace from Feb. 15 to May 15. All individuals and families eligible for marketplace plans in the 36 states that use the federal marketplace can apply for new coverage or update existing coverage. e administra- tion plans to attract enrollees through paid advertising and direct consumer outreach, according to e New York Times. e states operating on their own marketplaces may also re- open enrollment. ere are around 15 million uninsured Americans eligible for marketplace coverage, according to the Kaiser Family Foundation. e ASC industry could benefit if more of these people are insured, because they'll be able to access needed surgeries. "Depending on the unemployment rate, insurance coverage and deductibles, and awaiting COVID-19 vaccine adminis- tration, patients are slower to schedule surgery," Lori Sylves- ter, MSN, RN, administrator of Riverside Surgery Center in Columbus, Ohio, told Becker's ASC Review in a recent inter- view. "We are seeing a slow start to 2021. On a positive note, we are seeing [payers] driving volume to the ASC where it is more affordable, delivers high-quality care and great patient satisfaction." In addition to the potential expansion of insured Ameri- cans, Ambulatory Surgery Center Association CEO William Prentice said that CMS, commercial payers and employers are increasingly aware of the role ASCs can play in reducing healthcare costs. "We are seeing things like payers introduc- ing policies to steer patients to the lower-cost setting in ways that could be very beneficial to ASCs," he said. However, the expanded enrollment and coverage will not necessarily mean greater access if individuals aren't able to stay on long term or pay high deductibles. e administrator of Sinus Center Idaho in Meridian Crystal Baisch told Beck- er's her center has seen a significant decrease in patient vol- ume because of the expense associated with ACA plans. "Pa- tients can't afford to pay for insurance and use it," she said. e ACA marketplace premium rates vary by state. Indiana's ACA premium rate increased the most in 2021, at 10.5 per- cent. By contrast, Maine's rates experienced a 13.1 percent decrease. n Kaiser reverses decision to close Hawaii ASC, GI clinic By Eric Oliver O akland, Calif.-based Kaiser Permanente will continue to operate its ASC and gastroenterology clinic in Wailuku, Hawaii, The Maui News reported Kaiser announced plans to close its Wailuku Medical Office and relocate the services elsewhere in September 2020. The closure would've eliminated 28 jobs. Instead, Kaiser said Jan. 28: "After additional analysis, Kaiser Per- manente has found a way to allow the surgery center to remain open with all current services. This new path will require minor changes to allow for better patient flow and safety enhance- ments." Kaiser said a "new team" of people looked at the clinic and came up with "different and creative solutions" to keep it operational. Kaiser previously said the medical office building would require significant upgrades, and that it would transfer the services to Maui Memorial Medical Center because it was "more modern, uses the latest medical technology and has more space and greater patient capacity." Michelle Bausch, RN, a nurse in the ASC, said, "The relief was incredible because we have just been on pins and needles." After Kaiser announced the closure, a pair of unions rallied to protest the cuts. n HCA outpatient surgeries dropped 12.6% last year: 5 things to know By Laura Dyrda N ashville, Tenn.-based HCA Healthcare ended 2020 with declining outpatient surgery case volume and two fewer freestanding outpatient surgery centers than in 2019. Five things to know: 1. HCA reported 121 freestanding outpatient surgery centers in its network as of Dec. 31, 2020, down from 123 at the end of 2019. 2. The company reported 21 freestanding endoscopy centers at the end of last year, up from 20 endoscopy centers at the end of 2019. 3. The number of outpatient surgery cases dropped 12.6 per- cent in 2020, from 1 million in 2019 to 882,483 last year. 4. In the fourth quarter of 2020, outpatient surgery cases were 5.1 percent lower than the fourth quarter of 2019. 5. Outpatient revenue as a percentage of all patient revenue was 35.1 percent in 2020, down from 38.7 percent in 2019. n

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