Becker's ASC Review

20 Thought Leadership 'I don't see much positive': ASC leaders on Biden's 1st year By Patsy Newitt Four ASC leaders spoke with Becker's ASC Review on how President Joe Biden's administration affected ASCs in 2021. Editor's note: ese answers were edited lightly for clarity and brevity. Question: One year into Joe Biden's presidency, how has his administration affected ASCs and physician owners? Susan Feigenbaum, PhD. Professor at University of Missouri-St. Louis' Department of Economics: e real question is what hasn't President Biden done that will have an enormous impact on ASCs in 2022. First, supply chain issues will continue to plague ASCs, thereby driving up the cost of supplies. e president has not gotten involved in the battle for "site-neutral" payment policies between ASCs and hospital outpatient departments, although a Supreme Court ruling in June 2021 may serve instead to solidify this policy. is would have a dramatic, positive impact on ASC sector growth. Unfortunately, under the Biden administration, CMS restored Medicare's inpatient-only list, reversing a Trump plan to phase out the list over the next three years. e one thing the president did was enact a vaccine mandate for ASC employees, which would have had a potentially negative impact on up- ward of 20 percent of ASC personnel. e courts have set this aside for a number of states. Given the tightness in the labor market, this court action was definitely a welcome relief. Jeff Dottl. Principal at Physicians Surgery Center (Ventura, Calif.): Unfortunately, I don't see much positive in what has gone on so far. Both sides of the aisle seem to have gone off-the-rails crazy and spend their time sparring over anything and everything. If it doesn't score political points, then I don't see it getting much traction on the Hill. Maybe I'm overly pessimistic, but I don't expect anything but more of the same over the next three years. At least I won't be disappointed if Congress, the Senate and the executive branch actually acted responsi- bly and without hypocrisy. Bo Neichoy, MD. Co-owner of Surgery Center of Amarillo (Texas): e ignorance on a federal level as to what actually affects patients continues with the current administration. Because the government will always focus on providing insurance, they will continue to miss the big picture, which is the cost of delivering care. CMS removing 255 procedures from the ASC list and moving them back to the inpatient- only list is a perfect example. As technology, techniques and medicines advance, more and more procedures can safely and effectively be done in the outpatient setting. ere is no reason that hiatal hernias, appendectomies, gastric band removals, total shoulders and many more procedures cannot be done as an outpatient. Moving these back to the hospital setting increases patient responsibility and the amount the insurances have to pay for the facility fee portion, which ultimately gets passed back on to the pa- tient in the form of increasing insurance premiums and deductibles. n Will commercial insurers follow Medicare and move outpatient surgeries back to the hospital? By Marcus Robertson C MS finalized the 2022 ASC payment rules and ap- proved procedures list on Nov. 2, with 255 proce- dures removed from the outpatient surgery list. I. Naya Kehayes, principal and ASC practice leader at healthcare advising firm ECG Management Consultants, told "Becker's ASC Review Podcast" that ASCs that made operational adjustments to take advantage of the previous rules change could be in financial jeopardy. Question: Will surgery centers that already moved cases in have to move them back to hospitals? How much money is at stake? Naya Kehayes: I think the surgery centers that have already moved these cases are absolutely at risk to have to move them back to the hospital, especially with the Medicare population. To see this proposal revert back is really concerning, because those ASCs who have set up the programs to move the cases, they've made some capital expenditures, they've probably changed staffing structures and done a lot of things operationally to accommodate. It's definitely going to have an impact on them. I think more concerning is whether or not the commercial payers will follow suit. With respect to how much money is represented, there's no data out there right now. It's too soon to see how many Medicare patients the ASCs are doing on these new cases, because the Medicare reporting data is about two years old. So it's difficult to understand how much volume may have started to move with Medicare as a result of the 2021 rules that are going back. The first thing I would advise surgery centers to do is take a look at their commercial contracts that are based on the Medicare payment system. I would be going back to the commercial payer about sharing the concerns and potentially asking them for carve-outs from the methodology, because typically if you can get the case carved out in your contract, that will keep you from potentially having an adverse ef- fect, if that payer then converts over to the same covered procedures list as Medicare in 2022. It's going to be really important to review those contracts and address the issue with the payers. n

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