Becker's ASC Review

Sign up for the FREE Becker's ASC Review E-Weekly at www.beckersasc.com or email sbecker@beckershealthcare.com New Standard for Breach of Unsecured PHI. HIPAA requires notice to affected individuals, HHS and, in certain circumstances, the media when covered entities or their business associates discover a "breach" of unsecured PHI. HHS defines "breach" as the "acquisition, access, use, or disclosure" of PHI in violation of the Privacy Rule that "compromises the security or privacy" of the PHI. Previously in the Interim Final Rule, HHS defined the phrase "compromises the security or privacy of the PHI" to mean that the acquisition, access, use or disclosure "poses a significant risk of financial, reputational, or other harm to the individual," which became known as the "risk of harm standard." 21 After considering public comments, HHS determined that the risk of harm standard was too subjective and could be construed and implemented in a manner it had not intended. Accordingly, in the Final Rule, HHS revised the definition of "breach" to state that unless an exception applies, an impermissible use or disclosure of PHI is presumed to be a breach requiring notification unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the PHI has been compromised. To determine whether there is a low probability that the PHI has been compromised, the covered entity or business associate, as applicable, must conduct a risk assessment that considers certain factors to determine the overall possibility that the PHI has been compromised.  n Expect an Increase in New ASC Development: Q&A With Rob Carrera of Pinnacle III By Laura Miller  Question: Are there still opportunities out there for physicians to develop de novo surgery centers? Rob Carrera: In the past 12 months, we have experienced an uptick of groups interested in new surgery center development. Interest is coming from hospital/physician joint ventures as well as physician-only centers; a trend we anticipate going forward. A lot of these new centers are focusing on bringing higher acuity cases, traditionally performed as inpatient cases, into the outpatient arena. Orthopedic, spine and higher acuity general surgery cases are being driven into these ASCs. Q: Is this a widespread trend or are there certain markets that are more likely to foster de novo ASC development? RC: We've seen a lot of different scenarios. Physicians who were participating in multispecialty ASCs are forming larger physician groups and seeking opportunities to invest in their own single-specialty centers. Single-specialty joint ventures are resurfacing.  These trends are occurring in both larger markets and smaller markets. Q: Why are we seeing an uptick in de novo projects? What factors make it possible to develop these new centers? RC: I think a lot of it is due to financing. In the past year, banks and lending institutions have been making money available for these types of projects. As a result, some of the physician groups and hospitals have decided it's a good time to make these types of investments. For physician/hospital joint ventures, hospitals are realizing the value of aligning with physicians and developing relationships with groups they haven't had relationships with in the past. Hospitals are looking to form relationships with surgeons who were in another hospital's sphere of influence and new systems are developing relationships with physician groups. Rob Carrera A significant amount of hospital expansion has occurred in recent years and the next phase of their strategic planning is to look into joint ventures in areas hospitals may not have previously reached geographically. They might have a location in a new part of the city that allows them to work with a physician group who would have been out of their range in the past. For physician-only centers, we are seeing physicians exerting their influence by doing it on their own. In smaller markets, physicians may have thought about developing a center for a long time and are now getting around to solidifying that as part of their practice. sicians the opportunity to open an ASC within hospital-controlled real estate. Q: What advantages are there for physicians partnering with hospitals on joint venture ASCs? Q: What do surgeons need to consider when deciding to open a new surgery center? RC: There are a lot of advantages for physicians. ASCs will have access to patients they didn't have access to in the past if the hospital has an exclusive relationship with a payor or their own managed care plan. There are always capital needs for ASCs, and a hospital partnership can be advantageous for the ASC from that standpoint. Additionally, if there is a great geographic location for the ASC but it falls within an area around the hospital, a joint venture allows phy- RC: They need to look at where there is a need for their services. Some markets contain  an abundance of ASCs and adding another one in that area may not make sense. Ensure a feasibility study is undertaken to evaluate the proposed center to determine whether an ASC makes sense from a business standpoint. We've seen too many development projects based on a "build it and they will come" mindset which end up failing all too often. n

• Cover