Healthcare will once again be a key issue for the presidential election in 2020.
President Donald Trump's administration has removed regulations and championed more competition in healthcare over the past four years and many in the ASC industry anticipate a similar trend toward if he is elected for a second term. Joe Biden was vice president when the ACA was passed and implemented, and his campaign has issued the outline of a healthcare plan to ensure Americans retain insurance and access to care.
Which candidate will be better for ASCs? Eleven ASC owners and operators answer that question.
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Phillip Ramsey. Administrator of College Park Endoscopy Center (Overland Park, Kan.): President Trump will absolutely be better for ASCs as his plan is to keep commercial insurance intact and those companies competing for customers. The spirit of a competitive marketplace forces companies to lower costs while still delivering top-notch service. This is the American way. ASCs are the most effective way to deliver a number of surgical, diagnostic and preventive procedures. It just makes sense that those companies will find ways to send their customers to our centers.
Bertrand Kaper, MD. Orthopedic Specialists of Scottsdale (Ariz.): Let's review the facts:
Trump's tax cuts did not help ASCs (they only helped C-corporations, not PLLCs as most ASCs are structured).
Under Trump, total joint replacement surgeries have shifted off the inpatient only list, allowing these surgeries in the ASC setting. But the ASC reimbursements for total hips and knees leave little if any margin for profit for an ASC.
Under Trump (based on Republican budget balancing efforts), physician Medicare reimbursement for total joints will drop greater than 10 percent on Jan. 1, 2021.
And Trump will continue to attempt to do away with the ACA, which significantly reduced the number of uninsured patients who now can have procedures done at ASCs.
So, even though I'm not sure how Biden will handle many of the challenges, Trump has failed ASCs and physicians in general. Biden is the better choice.
Dennis Simmons. CEO of Wayne (N.J.) Surgical Center: Under Trump we might see less regulation or at least see some of the burdensome regulations go away and under Biden [we might see] more government intrusion plus more regulations. Our industry, especially freestanding ASCs, is the most heavily regulated industry in the United States.
Kristopher Karns. Business Office Manager of Advanced Spine Center of Wisconsin (Neenah, Wis.): Donald Trump is part of a lawsuit that will be going before the Supreme Court soon that could remove the entire Affordable Care Act. He has no known health insurance plan to replace it.
Joe Biden hasn't given in to the Medicare for All crowd, but he is in favor of helping as many people as possible have affordable access to health insurance. If that means continuing the ACA or modifying it, that is still unknown yet.
From that I would say the more people with insurance would allow us to see more patients. We do pretty expensive spine surgeries and that isn't usually affordable out of pocket without insurance. Ultimately, we have two responsibilities: to help as many people as possible and to stay profitable. If we aren't profitable, we won't be able to stay open to help patients. The more patients with insurance and access to affordable health insurance is better for the health and welfare of our community and our country.
Bill Berryhill, MD. Managing Partner of Heart of Texas Surgery Center (Waco): I do not believe that it will make a great difference who is elected president. The 2020 changes allowing an increased number of procedures to move to an ASC setting is being proposed to increase once again in January 2021. This experience has shown that more complex procedures can be done in ASCs safely. The movement of orthopedics, spine and cardiovascular into the ASC will provide such significant savings that the movement should continue with either Trump or Biden elected.
HHS has indicated their plan to do away with the 'hospital only' list of CPT codes by 2024. A report from the Ambulatory Surgery Center Association was quoted in Becker's ASC Review that possible Medicare savings of $73.4 billion through 2028 with movement of these procedures to the ASC setting. If only one half of those savings could be achieved, the economic forces should overcome all political or special interest obstacles. I remain optimistic about the future of ASCs with either candidate elected.
Jill Beadle. Administrator at DRMC Day Surgery Center (Denton, Texas): Trump. His policies are better for the economy as a whole. We get people back to work and secure in jobs with private insurance.
David Horace. Administrator of St Louis Specialty Surgical Center: I would assume that the current trend for ASCs would continue if Trump continues in office, and believe that he understands the economics for the Medicare Trust Fund buying services in an ASC at half the cost of what they cost in a HOPD; but that is an assumption nonetheless. I do not know if a Biden administration will usher in a return to the backroom, closed-door deals that [Bill Clinton] attempted to get done regarding healthcare reform. I would anticipate an expansion of coverage for people, not necessarily citizens, under Biden, and expect taxes to increase to pay for the expansion. I anticipate a departure from the current ASC economic trend, which would be unfavorable to ASCs.
Gregory Feltenberger, PhD. CEO of Idaho Urologic Institute and Surgery Center of Idaho (Meridian): President Trump has already proven his support for fair competition. He is a proponent of site neutrality and transparency, which help to level the competitive playing field w/ hospitals. ASCs have demonstrated time and again they are a lower cost, high-quality, and high patient and surgeon satisfaction option for appropriate surgical procedures. Maximizing the number of cases performed in an ASC is a very real solution to control (and possibly reduce) skyrocketing healthcare costs.
Taylor Cera. COO of Orthopaedic Surgery Center (Youngstown, Ohio): The administration that best continues to develop policy that increases price transparency, reduces Medicare regulations such as allowing all joint replacements to be performed in outpatient centers will be better for ASCs.
Price transparency will increase competition and allow ASCs to compete on price. Less regulation will allow and promote physicians to manage the care of their patients versus large institutions.
Ronald Wobig, MD. Beaver Sports Medicine (Corvallis, Ore.): Donald Trump [because he will] open up competition and fair posting of value of ASC compared to outpatient hospital payments for same procedure.
Michael Privitera, MD. University of Rochester (N.Y.) Medical Center: In healthcare and in this case ASC, paying attention to facts and science facts in particular really matter. Credibility of previously revered healthcare institutions like CDC now trashed for years due to political manipulations. Therefore Joe Biden.