Becker's ASC Review

12 ASC MANAGEMENT Aetna drops prior authorizations for cataract surgery By Patsy Newitt A etna will no longer require prior authorization for cat- aract surgery, according to a July 2022 email from the health insurance company. Here are three more updates for Aetna's commercial and Medicaid members: 1. Aetna will also no longer require prior authorization for video electroencephalography procedures. 2. For spinal fusion and cervical artificial disc surgery proce- dures, Aetna will no longer require precertification for the site-of-service only. 3. Aetna will require prior authorization for Opdualag and Alymsys, two new-to-market drugs. n ASC employee compensation packages are changing: 7 insights By Alan Condon N urses and medical assistants are among the most difficult positions to recruit in today's chal- lenging healthcare labor market, which has pushed many ASCs and medical practices to increase wages and strengthen compensation packages and benefits to address staff shortages. Here are seven ways medical practices are attracting staff, according to the June MGMA Management and Staff Compensation report: 1. Improved employee engagement efforts 2. Increasing paid time off or reducing schedules 3. Outsourcing for scribe work and medical coding 4. Providing salary increases ahead of schedule 5. More opportunities for remote work 6. Employing entry-level college students from local schools to build talent pipelines and developing those workers 7. Offering referral bonuses for staff members who help bring in new hires n ASC group IT breach: 2 million people affected By Marcus Robertson A hacker stole data from ASC and imaging group Shields Health Care, jeopardizing the personal information of 2 million people across 56 prac- tices and facilities in New England. From March 7-21, an unauthorized person accessed Shields' systems and took sensitive information, the group said. Shields was alerted of an incident on March 18, but data theft was unconfirmed at that point. Ten days later, the Shields said it learned of the data theft and launched an investigation. The group said it has no evidence to indicate identity theft or fraud was committed with the stolen data, which could include names, Social Security numbers, birthdates, home ad- dresses and medical information. The group said it is rebuilding some network systems and will directly notify those affected, where possible. n 'Our business model would implode': Why a physician group exited a payer's network By Laura Dyrda D avid Kowalski, MD, a physician with Springfield (Ill.) Clinic, a physician group with ASCs that dropped out of network with Blue Cross Blue Shield of Illinois last year aer a pay dispute, shed light on the details of the dispute and what lies ahead during a presentation at the Effingham (Ill.) County Chamber of Commerce in June. e Effingham Daily News reported Dr. Kowalski addressed the chamber during a June 3 luncheon. He said Springfield Clinic re- fused Blue Cross and Blue Shield of Illinois' contracted rates because it would have made it more difficult for the group to recruit and retain physicians. He said it would have been "fiscally irresponsible" for the group to accept the terms of the new contract. "We feel that if we cannot retain or recruit providers that our busi- ness model would implode, not unlike our local hardware store," he said. "We feel we owe our patients more — a future that is stable and they continue to receive great care for many generations to come." Dr. Kowalski said Springfield Clinic has been seeing Blue Cross and Blue Shield of Illinois patients out of network. Labs and X-rays for those patients are performed at HSHS St. Anthony's Memorial Hospital in Effingham until the two sides can agree on a new in- network contract. Springfield Clinic and Blue Cross and Blue Shield of Illinois are still in talks to renegotiate their contract, and in the meantime the clinic has a process to mitigate the financial impact to out-of- network patients. n

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