ASCA: How the Supreme Court's Healthcare Reform Ruling Affects Surgery Centers
The United States Supreme Court voted two weeks ago to uphold the ACA's requirement that individuals be required to have health insurance or face financial penalties, while striking down the law's requirement that states expand their Medicaid programs or face federal funding consequences. According to ASCA, neither of the rulings directly impacts daily operations of ASCs, but the law's transformation of the health insurance marketplace could potentially impact ASC business in the future.
The ruling leaves in place several provisions that affect ASCs directly, as summarized below:
Productivity adjustment. ASCs and other providers will see their Medicare updates reduced each year by a productivity reduction, mandated in the ACA. ASCA says it will continue to fight for adequate reimbursement and for ASC payment updates to be made based on the same system as HOPD payment updates.
Colorectal cancer screening cost sharing waiver. ASCs have benefited from a waiver of Medicare beneficiary cost sharing for colorectal cancer screenings. The provision is intended to incentivize patients to undergo colorectal cancer screening, which benefits ASCs because they are the lower-cost provider of this service.
Formation and existence of IPAB. The Independent Payment Advisory Board, created by the ACA, will remain operational. The board contains 15 unelected officials appointed by President Obama and is tasked with reining in Medicare costs beginning in 2014 by recommending specific Medicare reductions. IPAB would have to target ASCs, physicians, drug manufacturers and nursing homes for reductions in order to meet targets, since certain providers — including hospitals — are exempt from cuts until 2018.
Medicare ACOs. The Medicare Accountable Care Organization program established by the ACA will continue. Under the Medicare ACO program, health care providers are allowed to voluntarily form ACOs with the goal of reducing costs while providing high quality care. If these ACOs can generate savings while meeting quality targets, they share in the savings generated. The impact on ASCs, including whether they will be involved in functioning ACOs, remains to be seen.
Learn more about ASCA.
Related Articles on Healthcare Reform:
After the Supreme Court Decision: Anesthesiologists Must Proceed With Perioperative Care Model
How the Supreme Court's Decision Affects Healthcare
Supreme Court: PPACA, Individual Mandate Ruled Constitutional
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