Benita Tapia, RN, administrator and director of nursing at Beverly Hills, Calif.-based 90210 Surgery Center, joined Becker's to discuss what's missing in ASC conversations with payers. 

From ASCs' cost-savings potential to patient outcomes, 13 leaders joined Becker's to discuss the gaps in communication between  ASCs and payers. 

ASCs in many markets are struggling for leverage with payers, up against massive hospital systems and sparse cost information from the insurance companies. 

A federal jury has ruled that insurance brokerage Lockton Cos. and two brokers will pay $3 million to USI Insurance Services for allegedly breaching noncompete agreements, Business Insurance reported July 23. 

For many ASCs, navigating payer behavior and declining reimbursements is the biggest challenge in maintaining profits. 

Physicians and other healthcare providers should keep a sharp eye on potential Stark law allegations amid increasing federal scrutiny, law firm Arnold & Porter wrote in an April blog post. 

As many as nine out of 10 physicians say that prior authorization has a negative effect on patient outcomes, according to AMA’s survey of about 1,000 physicians nationwide.

The Department of Justice is doubling down on Stark law enforcement, with an uptick in complaints-in-intervention and Stark-related settlements, law firm Arnold & Porter wrote in an April blog post. 

Palo Alto, Calif.-based oncology company Guardant Health will pay $913,933 to settle allegations it violated Stark Law. 

The Federal Trade Commission is investigating DaVita and Fresenius Medical Care, two of the country's largest dialysis providers, over allegations their noncompete clauses illegally stifle smaller competitors, Politico reported July 13. 

Here are six updates on Medicare Advantage that have made headlines recently, as reported by Becker's since June 25:

Reimbursement differences between hospital outpatient departments and ASCs are a longstanding point of contention among ASC professionals, with Medicare ASC payments increasing only marginally while Medicare hospital pay has seen comparatively significant jumps.

Medicaid patient counts for self-employed and employed physicians were substantially lower than Medicare, according to Medscape's 2024 "Doctors Evaluate Medicare and Medicaid Report 2024," published July 12. 

Earlier this year, Congress reduced physician pay rates under Medicare Part B by 1.7%, following a 2% cut in physician reimbursements in 2023. 

Nearly half of physicians are in support of accepting more Medicare patients at their practice, according to Medscape's 2024 "Medscape Doctors Evaluate Medicare and Medicaid Report 2024," published July 12. 

As more procedures gain approval to be conducted on an outpatient basis, reimbursement differences between various care settings have gained significant attention in the healthcare industry — among patients, executives and clinicians alike. 

Cataract excision surgery with removal of lens, without endoscopic cyclophotocoagulation, was the most frequently conducted procedure at ASCs in 2023, according to an analysis by healthcare market intelligence company Definitive Healthcare.

The burden of prior authorization is growing as "payers seek new strategies to reduce outlays," according to a June 24 blog post from Coronis Health. 

The federal government is targeting New York City-based Mount Sinai Health System's inclusion of noncompete clauses in contracts for part-time physicians in a June 18 complaint filed with the National Labor Relations Board. 

The Federal Trade Commission's ban on noncompete clauses is facing a preliminary injunction from a federal court in Texas.