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How will Biden's $1.9 trillion plan affect ASCs? ASC leaders weigh in

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Some ASC leaders think President Joe Biden's $1.9 trillion American Rescue Plan could be a win for ASCs. 

The plan expands Affordable Care Act plans with no monthly premium to nearly 7 million uninsured Americans and extends eligibility for ACA health insurance subsidies to people buying their own health coverage on the marketplace.

With its passage, 63 percent of uninsured people are now eligible for financial assistance through the marketplaces, Medicaid or Basic Health Plans, according to a study by the Kaiser Family Foundation.

"The expansion will bring more patients to seek elective surgeries sooner," Liliana Lehmann, president of Axis HealthCare Partners, told Becker's "This will bring another opportunity for ASCs to be in the forefront as the lower-cost provider compared to hospitals."

The relief package will also increase subsidies to private payers for covering workers who were laid off, according to The New York Times. 

Some ASC leaders feel the expansion will bring patients to ASCs. 

"Expanded coverage will allow more people to seek the needed care that nurses, surgeons, anesthesiologists and [certified registered nurse anesthetists] at ASCs provide," Adam Spiegel, CEO of Irving, Texas-based NorthStar Anesthesia, told Becker's "Ultimately, more patients covered under health insurance would benefit patients, providers, ASCs and the broader community."

The private payer subsidies specifically could be a plus for ASCs, Anthony Molchany, CEO of Mercer-Bucks Orthopaedics and Mercer County Surgery Center in Lawrenceville, N.J. told Becker's.

"Private payers have long recognized ASCs and their financial benefit to membership," he said. 

Mr. Molchany, like Ms. Lehmann, foresees these companies continuing to migrate insured members to ASCs to capitalize on lowering costs with government subsidies, if private payers continue to develop cost-sharing models. 

"These private payers must continue to develop cost-sharing models using these subsidies that can be further integrated to reduce the overall consumer healthcare marketplace premiums," he said. 

John Prunskis, MD, CMO of Chicago-based DxTx Pain and Spine, told Becker's he feels the bill fails to address the central issue for ASCs in the healthcare industry — the disparity of reimbursement payments to ASCs and hospitals for the same procedures, which he says is "bankrupting Medicare and the health system."

"Hospitals get anywhere from two to five times the reimbursement for an identical procedure.  With the way they've structured the payment, however, the patient sometimes still has higher out-of-pocket costs," he said. "It's costing the taxpayers more, because it'll have a higher compensation for an identical procedure."

Regardless, these provisions are temporary and only last two years. Andre Blom, CEO of Illinois Bone & Joint Institute in Des Plaines, warns ASCs to not get ahead of themselves. 

"I don't think one should set policy based on the various elements of intent from the relief funds," he told Becker's. "The principles of long-term success remain the same."

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