Becker's ASC Review

9 THOUGHT LEADERSHIP care and population health management, the law is increasingly limiting innovation. Physicians and physician organizations are oen constrained by the technical requirements of the Stark law, which can inhibit creative and forward-thinking approaches to delivering high-quality, cost-efficient care. e financial risk inherent in value-based and population health models presents a significant barrier, particularly when physicians and physician organizations are unable to enter into arrangements with third parties that are willing to share or assume that risk. Additionally, the Stark law may restrict the formation of these collaborative relationships on technical grounds. e fair market value requirements can further complicate such arrangements, as they may not adequately capture or assign value to the efforts and infrastructure required for successful value-based initiatives. Population health and value-based models inherently consider the number of covered lives, indirectly tied to referral volume, which conflicts with current Stark law compliant FMV standards. Harpreet Pall, MD. CMO of Jersey Shore University Medical Center and K. Hovnanian Children's Hospital (Neptune, N.J.): While the Stark law continues to serve an important purpose in preventing inappropriate financial relationships and protecting patients, its complexity and rigidity oen create friction for physician organizations trying to innovate. Many contemporary care models, including clinically integrated networks, value-based arrangements and service line structures, require significant legal interpretation and compliance infrastructure to operationalize collaborations that are fundamentally aligned with quality and value goals. For physicians, this can translate into administrative burden, slowed program development and hesitancy to pursue potentially beneficial partnerships, even when patient interest is clearly at the center. Esme Singer, MD. CMO of Temple Faculty Physicians at the Lewis Katz School of Medicine (Philadelphia): is is actually extremely timely for us as we are working to expand our navigation programs for our patient population, which experiences significant social determinants of health barriers and low medical literacy. We oen know what care patients need and we have the ability to help facilitate care, but doing so requires building additional workflows solely to ensure compliance with the Stark law. e added layer is administratively burdensome and time-consuming, and in practice it can slow care delivery and make it harder to implement innovative, responsive care models. While I appreciate the original intent of the law, it seems misaligned and antiquated given how care is delivered and reimbursed today. Additionally, it seems inconsistent with what our patients actually want, which is help navigating the medical system. Without support, scheduling and coordinating care on their own can be confusing, time consuming and is associated with longer delays. is is bad for patients, especially among our vulnerable populations here at Temple. n Where ASCs are reaping the AI benefits By Cameron Cortigiano A s payer complexity and administrative burdens intensify, ASCs are turning to AI as a way to protect margins and efficiency by using it to manage prior authorizations and appeals, optimize OR performance and explore new clinical applications. For many ASCs, the efficiency boosts that AI provides have become necessary for survival, from coding changes, prior authorization and appeals. "In the fast-paced world of ASCs, billing teams are constantly juggling coding changes, payer denials, prior authorizations and time- consuming appeals. Efficiency isn't just nice to have — it's survival," Brooke Day, administrator at Hastings (Neb.) Surgical Center, said "That's why ChatGPT has become one of the most useful tools we've brought into our workflow. It's not just a novelty or a shortcut — it's a real solution to one of our biggest time drains: payer communication." When you talk about areas where medicine can be advanced, AI is one of, if not the first, improvement that comes up across all specialties. One example is in anesthesia, where AI could personalize preoperative risk and support physicians in their decision making. "AI-assisted systems will transform anesthesia by personalizing preoperative risk assessment and supporting intraoperative decision- making in real time," said Rebecca Bernstein. CEO and Founder of Innovative Healthcare Advisors in Vancouver, Wash. "Trained on EHR and physiologic data, these tools could outperform traditional risk scores, anticipate complications like hypotension, and recommend timely interventions. The key will be ensuring data quality, intuitive interfaces and clear regulation. AI will not replace anesthesiologists but amplify their judgment where it matters most." The gastroenterology space is also ripe for AI integration, especially on the academic side of things, according to Benjamin Levy III, MD, a gastroenterologist at University of Chicago Medicine. "From an academic perspective, the artificial intelligence technology is amazing because it really has the potential to help our first-year fellows in training get even more experience because they are seeing polyps for the first time," Dr. Levy said. "Especially in that first year of training, it's able to help fine tune what is a polyp versus a fold that just looks a little bit abnormal." While not every facility has integrated AI, nearly every single ASC is at least thinking about it and how AI can provide benefits. Kimel Park Surgery Center in Winston-Salem, N.C., is one of those ASCs that sees the potential value. "Currently, we have not implemented AI robustly at our ASC," Colby Marks, administrator at Kimel Park Surgery Center, told Becker's. "We are beginning to have conversations with our physician partners to analyze the benefits of utilizing AI in our revenue cycle management and our clinical operations. We see value in AI enhancing our OR utilization, metric tracking and communication across business units. We understand collectively that AI will impact our industry in the coming years. As such, we must evaluate all options to continue providing high quality patient care." n

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