ASC Industry Awareness
Why All the ASC Optimism? (March 2024)
Even with the challenges inherent in US healthcare delivery, surgery center leaders are enjoying a season of optimism… and why not? Technology advances continue to open opportunities for ASCs. The post-pandemic American public is much more aware of the significant value ASCs/OBSs/OBLs bring to their physical and financial health. Many surgical specialties are able to move more complex surgeries to ASCs than in the past. The increase in higher acuity cases is a big driver for growth, optimism, and satisfaction. ASCs more often have the recruiting advantage of surgeon ownership, which adds to the enthusiasm. Moreover, new ASCs are added every month, as attested to by the eleven new ASCs added in February.
ASC Opportunities for Growth Abound (June 2024)
New surgery centers are popping up around the country every month, demonstrating consistent and continued growth. Cardiovascular, robotic-assisted orthopedic/spine, and women’s services specialties are all ripe for more ASC expansion. In the area of women’s services, Florida has just become the first state to allow physicians to perform cesarean sections beyond hospitals at “advanced birth centers,” which enable overnight stays at clinics. ASCs are traditionally more preferred settings for surgeons, which is creating an edge in the battle to keep physicians and is creating another, largely untapped, growth opportunity. Estimated ASC growth from $36B last year to $57B in 2031 indicates significant future profitability opportunities for those ASCs that prepare and put themselves in position to grow with the industry.
Healthcare Industry/Trends
Consumers’ Growing Interest in Understanding Coverage (March 2024)
“Shrinkflation” is back in the American psyche in 2024 and employers and healthcare insurance subscribers are feeling it as they get less for their money. This dynamic is pushing consumers to take more interest in better understanding their coverage and out of pocket costs. Health insurers are experiencing increasing pressure to be more transparent in their pricing. Shrinkflation pressures along with a convergence of CMS pressures are making Medicare Advantage Exhibit A. These Advantage alternatives to traditional Medicare sold by commercial health insurers had more beneficiaries than the traditional plans, but market and CMS forces are causing them to grow skimpier and costlier for subscribers at the same time, which is causing some systems to drop Medicare Advantage plans.
Jobs Available in Healthcare for Next Decade (September 2024)
Our continuing projected physician shortage is well documented. However, less well-rehearsed is the shortage of nursing assistants, which is projected to be the greatest US healthcare staff shortage over the next five years, with a deficit of at least 100,000. According to the US Bureau of Labor Statistics, healthcare is the industry with the highest total of projected new jobs through 2033. Leading the pack are home health and personal care aides, with a whopping 820,500 projected. Staffing shortages, an aging demographic, cost containment, and technological capabilities all play a role in that statistic as they do in the continuing push for more virtual care.
Healthcare M&A, Valuation, Revenue Cycle
Urgent Care, Stryker, RCM, AI (October 2024)
Community Health Systems is acquiring ten urgent care centers in Arizona as it continues its years-long efforts to sell off hospitals, replacing them with outpatient services. On the medical equipment side of the healthcare universe, Stryker has been busy, completing their acquisition of Care.ai to strengthen their healthcare IT and wireless medical device book of business and the purchase of a pain management company. End-to-end revenue cycle management companies continue growing in the current healthcare market as they pick up the pace of buying out specialized revenue cycle leaders. An AI prior authorization platform announced that it closed a $25 million investment round, with several payer participants.
Out-of-Network Watch
Latest on NSA and OON BCBS Wrangling (November 2024)
The federal regulators appear to have snatched a partial win from the jaws of defeat in the interpretation of how the qualifying payment amount in No Surprise Act disputes will be determined, to the chagrin of providers. When Congress passed NSA in 2020, few believed the legal maneuvering would still be active. Some policy experts are advocating less tortured solutions to how networks and unpaid patient debt function. Medicare Advantage plans are providing inaccurate in-network lists, which creates havoc for patients and providers that are out-of-network with no contract for 2025. In a win for out-of-network providers, a $421M legal judgment was awarded in October due to BCBS of Louisiana’s claims underpayment. BCBS plans to appeal the decision.
Healthcare Digital Transformation Watch
Healthcare Data Breaches Warrant Stronger Response (April 2024)
The Change Healthcare (UHC) data breach has put healthcare on notice that it is in threat actors’ crosshairs. UHC advanced over $3.3 billion to affected providers in addition to a $22 million ransom it paid as UHC shares have fallen 6%. A second ransomware group is now reportedly seeking to extort Change Healthcare in a smaller data breach. Another ransomware group claims to have made $3.4 million selling data stolen from a Chicago children’s academic medical center. Healthcare data is valuable on the dark web. Ransomware attacks are evolving due to franchised malware enabling more of it and data being stolen, not just locked up. Healthcare organizations are employing more strategies to prevent and respond to cyberattacks while a former CMS Administrator says it is time to turn front-line healthcare cyber defense over to autonomous systems.
Legal
Cybersecurity Performance Goals for Healthcare (April 2024)
From the office of Jon Sistare, JD, Attorney at Law
On January 24, 2024, the Department of Health and Human Services (DHHS) released voluntary Cybersecurity Performance Goals for the healthcare sector. These goals include 10 “essential” and 10 “enhanced” goals. The health care cybersecurity performance goals directly address common attack vectors against U.S. domestic healthcare providers.
These cybersecurity performance goals are targeted at defending against the most common tactics used by cyber adversaries to attack health care and related third parties, such as exploitation of known technical vulnerabilities, phishing emails and stolen credentials. The DHHS recommends that all components of the health care sector implement these practices including third-party technology providers and business associates. The goals can be found at https://hphcyber.hhs.gov/performance-goals.html.
At a Glance
First of Their Kind Healthcare-Focused High Schools (April)
Serving 6,000 Students in 10 Communities across US
New Orthopedic MBA Program Begins (April)
Grace College Launches Program in Warsaw, IN, an Orthopedic Hub
Cost Plus Model Changing Pricing of Other Brands (June)
Optum Rx Shifting to Competing Pricing Model for 2025
Letter to HHS Detailing Egregious Insurer Denials (July)
20% of Claims Denied, Some without Even Opening Patient File
National Healthcare Spending Grows 7.5% to Nearly $4.8T (August)
At 5.6% Growth Nation Will Spend $7.7T by 2032
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