White Papers

• Out-of-Network Payment Squeeze: 4 ASC Trends and Challenges: Recent moves in some states by insurers to restrict the use of out-of-network facilities by their members have created a headache for many ASCs around the country. Although out-of-network facilities continue to be successful, a growing resistance from insurers against paying billed charges and, in many cases, reasonable and customary rates to out-of-network providers signals a growing challenge for ASCs. This article discusses four practices ASCs should be aware of and be resistant of whenever possible. (July 15, 2009)

• Healthcare Reform: An Overview of Key Concepts: This article describes the overriding goals and concepts discussed in the healthcare reform plans currently under consideration by the Congress. Specifically, the article discusses the concept of a public option as part of healthcare reform, the concept of providing universal coverage and the issue of how to pay for healthcare reform. The article also touches on several other key issues. (July 2, 2009)

• HIPAA Settlements Between Healthcare Providers and the Government: HHS relied mainly on voluntary compliance measures to address HIPAA violations until approximately one year ago. Recent settlements between HHS and healthcare providers suggest, however, that resolution settlements could be more severe if a violation happens today. HHS may still rely on voluntary compliance, but it is also willing to use other measures, like fines, resolution agreements, and detailed corrective action plans. (June 23, 2009)

• A Practical Compliance Plan Approach for ASCs: This article provides an overview list of the steps to be taken to implement a compliance plan for an ASC. (May 26, 2009)

• 17 Key Legal Issues of 2009: There are a number of legal and regulatory issues that are impacting ASCs. These range from antitrust cases to safe harbor issues to new Conditions for Coverage, which place specific additional burdens on surgery centers, as well as several other issues. This article provides a short summary of 17 key legal issues. (May 14, 2009)

• 3 Core Models for Delivering Anesthesia Services: Trends, Legal Issues and Observations: This article briefly describes three different methods of delivering anesthesia services. Then, it discusses a few legal issues related to anesthesia services. Finally, it provides several different observations related to trends in anesthesia services. (Apr. 28, 2009)

• Core Trends in ASCs - 14 Observations: This article briefly highlights 14 observations regarding the current ASC industry. It outlines a number of thoughts on trends and challenges being faced by ambulatory surgery centers. (Apr. 27, 2009).

• Developing Centers of Excellence-Key Concepts, Strategies and Tactics: The importance of developing outstanding programs, often referred to as "Centers of Excellence," in specific specialties has taken on new importance in critical specialties such as orthopedics, neurosurgery and spine, cardiology and oncology. This article discusses how developing a grand vision or plan comprised of clear goals can guide the development of a Center of Excellence. This article then examines specific strategies and tactics that can be used to implement such a plan. (Apr. 4, 2009).

• ASC Transactions - An Overview and Primer of Key Issues: The number of ASC purchase and sale transactions remained high in 2008. The most common structures for the typical transactions were as follows: (1) the acquisition of a majority interest in an ASC by a forprofit, strategic acquirer which focuses as a core business in buying majority interests; (2) the acquisition of a minority interest in an ASC by a for-profit, strategic acquirer which focuses as a core business in buying minority interests and/or investing in turn around centers; and (3) the hospital acquisition of a minority or majority interest in a local ASC. In a fourth, less common structure, a hospital purchases an ownership interest in an ASC side-by-side with a third-party ASC management company. This article discusses several of the business and legal issues related to ASC acquistion transactions. (Feb. 19, 2009)

• A Physician Practice Primer: Seven Steps to Profit from Adding New Ancillary Services: Adding an ancillary service such as physical therapy, imaging or ultrasound services to your medical practice may seem like an easy opportunity to capture revenue you are giving away in referrals to providers outside of your organization. While an ancillary service can boost profitability and improve your patient care offerings, its addition should not be taken lightly, says Stephen Dobias, principal on the Health Care Team of Indianapolis-based Somerset CPAs. Dobias suggests seven steps you should follow to determine whether the addition of an ancillary service is right for your medical practice and how to ensure the ancillary service gives you a strong return on your investment. (June 3, 2008)

  Note: This story features a sample proforma found at the end of the piece.

• Merging Two Centers - Can it Solve Certain Problems?: The merger of two centers with each other has not been a traditional strategy for surgery center growth over the past 10 years. Traditionally, merging two centers, absent certain motives such as redeeming certain physicians, has been viewed more as a negative than a positive. Mergers would often expand annual fixed costs and leave more physicians owning interests in two centers with less of a definite connection between the physicians that practice at the specific centers. For example, now you might have 40 physicians who have interests in two different centers instead of 20 physicians at each center who are highly tied to the centers. Notwithstanding this traditional hesitancy to merge centers, we are currently seeing a significant increased interest in the merger of surgical centers. This article walks through a specific case study of a merger of two centers and explains some of the reasons a merger can be attractive. (May 27, 2008)

• Hospital Leader Shares Insight on Current State of Hospitals and Health Care: In just eight years, BayCare Clinic has become an extremely profitable, high-quality, physician-owned organization serving the Green Bay, Wis., community. The chief medical officer for BayCare is Paul Summerside, MD, FAAEM, who also serves as the president of the board of managers for Aurora BayCare Medical Center in Green Bay. Dr. Summerside shares his thoughts on the major challenges currently facing hospitals, why many hospitals are struggling to find sustainable success and what still keeps him excited about healthcare. (May 27, 2008)

• Key Regulatory and Diligence Issues in Healthcare Real Estate Acquisitions: Healthcare regulatory diligence can be critical where a real estate investment trust (REIT) or other buyer acquires a portfolio of properties such as a medical office building from a hospital or other provider. (Feb. 08, 2008)

• Four Cornerstones to Strategic Planning for ASCs: This article provides insight into four different concepts to strategically attack and manage operations in a surgery center. (Jan. 31, 2008)

• Ambulatory Surgery Centers and Physician-Owned Hospitals: Ambulatory surgery centers and physician owned hospitals each offer similar advantages to consumers and to payors. (Jan. 31, 2008)

• Stark III - Nine Areas of Concern: The Center for Medicare and Medicaid Services (“CMS”), on July 2nd, published their thoughts relating to the impending Stark III Rules. In addition to certain specific proposed rules, CMS solicited comments on several areas of concern. (Jan. 18, 2008)

• CMS Issues Final Phase III Regulations: The Center for Medicare and Medicaid Services ("CMS"), on September 5th, published a final rule implementing Phase III of Part II of the Stark Act (the "Stark III Regulations"). (Jan. 17, 2008)

• Ambulatory Surgical Centers -- An Analysis for the Next Five Years: The last several years have been an outstanding time for surgery centers. There has been explosive growth in the overall industry and in the number of surgery centers. There have also been a great number of developments that have been extremely positive for the surgery center business.

• Investing in Health Care -- A Story of Political Clout, Successful Niches and Recurring Cycles: The U.S. health care industry is an estimated $1.8 trillion industry and accounts for more than $1 of every $7 spent in the nation’s economy. (Jan. 11, 2008)

• RE: Buying and Selling ASCs; Under Arrangements Structures; October 18th to 20th ASC Conference:  This letter discusses the current market pricing of transactions for ambulatory surgery centers and "under arrangements" models – are they legal or illegal? It also touches on a few other issues. (July 01, 2007)