Crisis Averted? How Raising the Debt Limit & Ending Government Shutdown Impacts ASCs

Capitol BuildingPresident Barack Obama has signed a bill to end the partial government shutdown, fund the government through Jan. 15, 2014 and increase the debt limit through Feb. 7, leaving healthcare reform largely unscathed, according to a Chicago Tribune report.

The bill lifted the federal debt limit to allow both houses of Congress to develop a long-term deficit reduction plan by Dec. 13. A huge point of contention between Democrats and Republicans in the recent dealings has been whether aspects of the Patient Protection and Affordable Care Act could be negotiating chips on the table.

Some members of the Republican Party have demanded linking changes for healthcare reform legislation to the debt limit or government spending bill, but after the most recent standoff Republican Senator John McCain advised Republicans not make those demands in future negotiations, according to the report.

The only change to healthcare reform in the bill signed last night includes "verification procedures for those seeking subsidies," meaning individuals who receive subsidies will have their income verified. It does not defund healthcare reform or eliminate the medical device tax, implemented at the beginning of 2013, which was one of the Republican demands.

So what does all this mean for healthcare providers, particularly ambulatory surgery centers?

•    Ending the government shutdown means the Centers for Medicare and Medicaid Services will return to full functions, including certification and recertification efforts.
•    Individuals will continue to have access to and enroll in health insurance exchanges. After glitches with the initial roll-out, more are expected to enroll before the Feb. 15, 2014 deadline.
•    Social Security, Medicare and Medicaid payments will be sent out.
•    Federal employees who were furloughed are expected to return to work today, according to a News Observer report, and paychecks aren't expected to be delayed for most federal employees.

A Politico report positions Democrats and President Obama with the stronger bargaining position in the coming debates after last night's bill was signed. However, by the time limits set for next year, health insurance exchanges and many other aspects of the healthcare reform legislation will already be up and running.

"Many patients are facing issues of obtaining insurance policies with very large deductibles in order to afford the policy," said Nurse Administrator of Surgicenter of Bel Air (Md.) Janice Stewart, RN, BSN, in a Becker's ASC Review report. "They are then not able to have any elective surgery because they cannot afford the deductible. We have seen many cancellations due to patients deciding they just cannot afford the deductible or the time off of work. We have been working with patients to make payment plans and alternate collection plans, but then this affects our upfront capital. The volumes have decreased from several years ago and I think this is in part due to the patients' inability to pay. We have been looking at ways to help patients afford to have surgery."

According to a report in Bloomberg Busienssweek, Tea Party Republicans have vowed to continue fighting against healthcare reform legislation in the upcoming budget battles. However, more moderate Republicans are not expected to follow suit and likely other aspects of the national agenda—such as tax reform—will be more prominently negotiated. As a result, many surgery centers will continue to face the same challenges and opportunities from healthcare reform.

"Overall, PPACA presents ASCs with opportunities," said Kim White, MDA, a consultant with Numerof & Associates in a Becker's ASC Review report. "The challenge is quantifying those opportunities and being disciplined in their approach. They need to make strategic decisions in where they are going to play and then be disciplined in capturing data to substantiate their differentiation."

However, there are still several challenges at the ground level and whether individual centers will be able to overcome these challenges remains to be seen.

"At this point I don't know if anyone really knows what the end results of healthcare reform will bring," said Lynn Winter, RN, administrator of Surgical Center of St. Louis in Bridgeton, Mo., in a Becker's ASC Review report. "The biggest change for us is the physician's fear of inability to maintain a private practice. This fear is leading them to become hospital employed, which will dictate where they perform their cases (pulling them away from our ASC) and how they will provide care."

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