Becker's ASC Review

8 ASC MANAGEMENT Payers splitting with health systems: How ASCs could be affected By Patsy Newitt C ontract disputes and payer splits are threatening coverage nationwide, and some ASCs are being affected by the parties unable to meet year-end or looming deadlines. Here are four disputes or splits affecting ASCs and clinics: 1. Although Regence BlueShield of Washington came to an agreement to keep commercial members in network at the Polyclinic in Seattle and the Everett Clinic, the payer's Medicare advantage members are still in limbo. Regence BlueShield of Washington's contract with Optum-owned Everett Clinic and Polyclinic expired Dec. 5, and the two sides on Dec. 22 reached an agreement to keep commercial members in network. But negotiations between the clinics and Regence BlueShield are ongoing, e Daily Herald reported Jan. 10, and multiple Regence BlueShield Medicare Advantage members told the newspaper they had been denied care at the Everett Clinic because their plans are now out of network. 2. Blue Cross Blue Shield of Tennessee ended its relationship with Memphis-based Methodist Le Bonheur Healthcare, and two ASCs are affected. In total, 11 locations have been removed from the networks, including Methodist Le Bonheur Germantown Surgery Center. Another ASC, Wolf River Surgery Center, will be out of network effective Oct. 23. 3. Anthem Blue Cross could go out of network with Fredericksburg, Va.-based Mary Washington Healthcare if the two sides cannot agree on a new contract by March 1. According to a statement on Mary Washington's website, the health system's ASC and endoscopy center would be affected. 4. A contract between Blue Cross Blue Shield of Texas and Austin-based Ascension Texas is set to expire Jan. 31, which would force 10 Texas hospitals, 10 ASCs, two medical centers and 32 hospital-based clinics out of network. Most of the potentially affected centers are located in the Central Texas and Hill Country regions. Negotiations between Blue Cross and Ascension have been going on for months, according to a Jan. 4 report from MySanAntonio. n Coast Surgery Center sues major insurance providers over reimbursement disputes By Riz Hatton C oast Surgery Center in Huntington Beach, Calif., is suing several major insurance providers for alleged "illegal, coercive, unfair, fraudulent practices, bad faith and deceptive advertisements." The ASC allegedly saw a decrease in insurance companies' usual, customary and reasonable rate, which dropped below the 2018 Medicare rate, according to a Jan. 16 press release from Coast Surgery Center. The surgery center alleges that some claims were not paid at all. Coast Surgery Center has accumulated more than $6 million in bills since 2019, according to the release. The insurance providers Coast Surgery Center is suing include UnitedHealthcare, Cigna, Aetna, Anthem Blue Cross California, Blue Shield of California, the Blue Cross Blue Shield Association and all BCBS affiliates. n Certificate of need changes in the Carolinas: What ASCs need to know in 2023 By Patsy Newitt C ertificate of need laws could change drastically in North and South Carolina in the next year, according to a Jan. 11 article in JDSupra from the law firm Nexsen Pruet. The South Carolina Department of Health and Environmental Control has proposed to increase the threshold for capital expenditures that require a certificate of need to more than $5 million and the threshold for equipment acquisitions that require a CON to more than $2 million. Additionally, these thresholds will be indexed to account for inflation. These amendments now await the South Carolina General Assembly to take action. In South Carolina's last legislative session, the Senate passed a bill that would have repealed the CON law, but it died in the House. "We expect there to be another attempt to rescind or significantly modify the CON program in 2023," the report reads. In 2021 in North Carolina, the state increased the CON capital threshold from $2 million to $4 million and increased the threshold for equipment acquisitions that require a CON from $750,000 to $2 million, as well as indexing for inflation. In August, the North Carolina Treasurer filed an amicus brief challenging the legality of the state's CON laws. According to the report, if government officials continue to raise concerns over their state's law, "It is possible that 2023 could turn into a crucial year of legislative debate over the future of the program as a whole." n

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