5 Key Healthcare Climate Updates for ASC Leaders to Know

Laura Dyrda - Print  |

Here are five updates on healthcare policy, programs and projections for ambulatory surgery center leaders to know.

1. After the House of Representatives passed the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 with an amendment that would delay the individual mandate until 2019, the White House released a statement indicating President Barack Obama would veto the repeal in its current state. The current SGR fix expires April 1, and if new legislation isn't put in place Medicare rates will be cut nearly 25 percent.

2. The Patient Protection and Affordable Care Act health insurance exchange included 4.2 million enrollees as of March 1, with 31 percent being 34 years old or younger and 25 percent being between 18 and 34 years old. Uninsured Americans have until March 31 to enroll in an insurance plan, or face fees. A report from the Kaiser Family Foundation says the premium "death spiral" predicted by some is unlikely to occur and insurers can expect to earn profits even if only 25 percent of the exchange enrollees are young adults. According to a Gallup-Healthways Well-Being Index report, the percentage of uninsured Americans dropped to 15.9 percent, down from 17.1 percent during the fourth quarter of 2013.

3. CMS issued a final rule establishing the Basic Health Program, which allows states the option to provide health insurance for low-income individuals who don't qualify for Medicaid. Beginning in 2015, states will have the option to offer benefits to people at or below 200 percent of the federal poverty level who would otherwise be eligible to purchase coverage through the state's health insurance exchanges.

4. Sens. Robert Menendez (D-N.J.) and Deb Fischer (D-Neb.) have introduced the Two-Midnight Rule Coordination and Improvement Act, which would establish new guidelines for CMS' creation of criteria payment methodologies concerning short inpatient hospital stays. The two-midnight rule was established by the 2014 Medicare inpatient prospective payment rule. According to the policy, inpatient admissions spanning at least two midnights qualify for Medicare Part A payments. Inpatient stays lasting fewer than two midnights must be treated and billed as outpatient services. CMS introduced the policy to better monitor Medicare reimbursement for short inpatient stays and ensure inpatient admissions are medically necessary. Hospital leaders have fiercely opposed the rule, saying it is unclear and undermines the medical judgment of physicians.

5. Under current law, the CBO projects net federal spending for major healthcare programs will grow from approximately 4.5 percent of gross domestic product in 2013 to more than 6 percent of GDP in 2024, according to a blog post by CBO Director Doug Elmendorf, PhD. Major healthcare programs include Medicare, Medicaid, the Children's Health Insurance Program and the subsidy program helping people pay for coverage through the Patient Protection and Affordable Care Act exchanges. Under current law, the CBO expects the number of Medicare beneficiaries will grow by more than a third during the next decade, as the population ages. By 2024, about 60 percent of baby boomers will be eligible for Medicare.

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