Becker's ASC Review

53 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine – Call (800) 417-2035 tive deadline until August. The American Health Information and Manage- ment Association predicted that the delay of ICD-10 implementation would cost the healthcare industry anywhere from an additional $1 billion to $6.6 billion. Despite the delay, healthcare stakeholders appear to be behind on preparing for the switch. Only 50 percent of providers have completed im- pact assessments, according to a Workgroup for Electronic Data Interchange survey. A quarter of vendors will not have updated software available until next year. On the other hand, nearly 75 percent of payers have completed impact assessments. 4. Narrow networks. In the new healthcare landscape, narrow networks are one of the predominant strategies for containing costs. Last year, the con- cept was just gaining steam, but now these networks have proliferated across the country. As of yet, there has been little to check this growth, but state legislation has turned its eye to regulation. In South Dakota, voters will de- termine whether or not narrow networks will even be allowed to exist within the state. Voters will decide whether patient choice, limited by narrow net- works, or cost containment, supported by these networks, is more important. If passed, the legislation would require South Dakota payers to accept claims from any provider that meets the payer's standards. In California, S.B. 964 was signed by California Gov. Jerry Brown. This legis- lation does not strike down narrow networks, as South Dakota's proposal does, but increases oversight. As a result of the legislation, all plans sold through the state's insurance exchange, Covered California, will be re- viewed annually. All plans will be scrutinized to determine if they meet access, network adequacy, continuity of care and quality management compliance standards. Thus far, ASC attitude towards narrow networks has remained cautious. Some centers have participated in health insurance exchanges willingly, while others are taking time to consider how exchanges and accountable care orga- nizations will affect the industry. 5. Anesthesia mergers and acquisitions. Uncertainty is a strong impetus behind the consolidation that ASCs and healthcare as a whole have witnessed. The upswing in mergers and acquisition activity has been particularly marked in the anesthesia field. Publically traded companies such as EmCare, MEDNAX and TeamHealth have been key players in this field. Additionally, privately-held companies and private equity sponsored companies such as North American Partners in Anesthesia, Sheridan Healthcare and U.S. Anesthesiology Partners have joined the fray. In Janu- ary alone, four major anesthesia mergers were announced or closed. His- torically, the anesthesia market, much like the ASC industry, has been frag- mented, but now pressures in healthcare are highlighting the "strength in numbers" strategy. 6. Price transparency. The market for healthcare transparency is expect- ed to grow by 55 percent by 2016 to reach a value of $3.09 billion, according to a Healthcare Finance News report. In 2013, price transparency was a hot term in healthcare, but for the most part actual prices remained in the dark. This year, however, there have been several significant moves forward with an effort to reveal healthcare costs to the public. In October, Massachusetts became the first state to require health insurers to provide real-time pricing for procedures. Two new state laws that aim to drive consumerism in healthcare in Maine recently took effect. Instead of requiring payers to shed light on pricing, the Maine laws require hospitals and ambulatory surgery centers to provide the average charge for any service or procedure on request and require healthcare providers to gather a list of their most common procedures, anything per- formed more than 50 times a year and the price set for uninsured patients, respectively. Earlier in the year, a number of ASCs took the initiative to post prices inde- pendent of a legislative mandate. MEDARVA Stony Point Surgery Center in Richmond, Va., posted the out-of-pocket costs for more than 30 of its most common surgical procedures. Monticello Community Surgery Center in Charlottesville, Va., opened this year, but before even performing its first case announced the intent to offer patients price transparency. A number of websites designed to offer price transparency in healthcare were launched this year. In May, Jeff Blankinship, president of Surgical Notes and Surgery Center Network, founded the I Need a Surgery Platform, which is designed to connect insured and uninsured patients with ASCs, which will offer pre-determined, all-inclusive prices. The website Wisconsin PricePoint launched for the comparison of inpatient and outpatient prices in the state. The website CO Medical Price compares hospital prices for knee replace- ment, total hip replacement, uncomplicated vaginal birth and cesarean birth. Along with ASC prices, nine additional services will be added by the end of the year. 7. Bundled payments. Bundled payments, much like narrow networks and price transparency, have been selectively tested; not all healthcare stake- holders are on board yet. One of the biggest stories in bundled payments revolved around a three-year study of a pilot program launched in California. The program, launched by the Integrated Healthcare Association in 2010, aimed to adopt bundled payments for orthopedic procedures among com- mercially-insured patients under the age of 65. A RAND Corporation study revealed that the pilot program failed to meet its cost-savings goals. The par- ticipating ASCs successfully offered bundled payments, but payers did not did not direct patients to the centers. Despite the results from that particular study, bundled payments continued to gain traction this year. After the release of the RAND study, CMS an- nounced that 4,100 new providers will test out Medicare bundled payment contracts, joining 2,400 providers already testing the payment model under the Affordable Care Act's Bundled Payments for Care Improvement initiative. CMS is not alone in continued pursuit of bundled payments. Commercial payers are also involved in trial runs. 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