Will Biden, Congress be friendly to ASCs and physician ownership?

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The Trump administration championed competition in healthcare that benefited ASCs and accelerated the migration of more procedures from hospitals to surgery centers. Will the current administration continue these efforts and support physician ownership?

It's too early in President Joe Biden's administration to know for sure, but there are some initial indicators.

"With Biden's selection of Xavier Becerra [as HHS secretary] and [Liz Richter as] acting CMS administrator, I assume that much attention will be focused on strengthening ACA plans and finding reductions in healthcare costs, such as value-based care and bundled pricing," said Brian Bizub, CEO of Raleigh (N.C.) Orthopaedic.

Over the last four years, ASCs have seen more surgical cases move from the hospital to ASC driven by more advanced technology, surgeons becoming comfortable with less invasive procedures, and payers, including CMS, approving more complex surgery for the ASC. The migration of these cases reduces overall cost to the healthcare system, and ASCs are working to standardize policies and procedures to reduce risk. But there are challenges ahead.

"The biggest challenge is with every move of an inpatient surgical case to the ASC is a substantial reduction in reimbursement, leaving little to no margin for profit unless the government engages in equipment, instrumentation, supply chain and implant costs similar to CMS's competitive bidding process on durable medical equipment and average sales price for medications," said Mr. Bizub.

Anthony Molchany, CEO of Mercer-Bucks Orthopaedics and Mercer County Surgery Center in Lawrenceville, N.J., is hopeful the Biden administration and Congress will recognize the role ASCs play in the healthcare ecosystem and continue developing policies that will support ASC operations.

"Considering this administration's overall position on the ACA, HHS must continue to focus on those procedures that are safe and effective within an outpatient setting and capitalize on the economics these lower cost procedures provide to consumers and continue to further integrate ASC policy and achieve maximum benefit to this administration's overall healthcare policy agenda," he said.

Given the Biden administration's focus on lowering healthcare costs while improving access to care, Mr. Bizub said he doesn't anticipate new regulatory requirements because ASCs are already so highly regulated at the state and federal level.

"Biden's administration will most likely expand the Price Transparency Act mandated at the hospital level to all ASCs in the near future," he said. "As we know, [higher] pricing does not always coincide with providing the highest quality care."

He also sees Congress being more friendly to physician ownership than in the past, as physicians have more autonomy in the surgical cases performed at their centers.

"In the past, Congress has never been supportive of physician-owned ancillaries," said Mr. Bizub. "However, I feel the mood is changing with the relaxing of the Stark Law and the focus will be on controlling the number of ASCs in a given geographical area. In my opinion, I think that the answer is that Congress will be less interested in ownership, whether it's insurers, physicians or health systems, and more interested in regulating the number of new ASCs and their participation in ACA plans."

The Ambulatory Surgery Center Association has advocated for ASCs on Capitol Hill for decades, and the organization will continue its work with the new administration.

"ASCs continue to be a high-quality, cost-effective alternative for the Medicare program, its beneficiaries and privately insured patients across the country, and ASCA is looking forward to working with the Biden administration and our current Congress to increase patient access to the services ASCs provide," said William Prentice, CEO of ASCA. "The ASC model is not a partisan issue and continues to have support from Democrats and Republicans."

 

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