1. Reimbursement. ASCs continue to struggle to negotiate fair insurance contracts with commercial insurers even as they’ve seen cuts in their Medicare payments from CMS, Ms. Bryant says.
“Those payment issues come both from Medicare and private payors,” she says. “Some GI procedure payments were cut 5 percent in 2008 and will see a 7 percent reduction in 2009. But once Medicare cuts, private insurers often follow and try to negotiate a percentage of Medicare payment. Or private insurers may choose not to pay for certain anesthesia procedures.
“ASCs also continue to struggle with exclusive contracting arrangements between hospitals and insurers,” she says. “It’s hard for small businesses in a market to rebound when major hospitals or health systems negotiate exclusive contracts with health plans and freeze out smaller players like ASCs. We expect insurer payments and contracting will continue to challenge ASCs.”
2. Changes in Medicare Conditions for Coverage. Ms. Bryant points out that Medicare standards for ASC certification are currently undergoing a major overhaul and are expected to be introduced May 18, 2009.
3. Fighting off negative government regulation, particularly at the state level. Ms. Bryant identifies several states, including Maryland, Minnesota and Washington, that attempted to apply special taxes on cosmetic procedures, for example.
“So far they have failed,” she says. “But we have to be vigilant. Sometimes states impose unnecessary and costly requirements on ASCs.”
4. General business and economic issues. Many ASCs still face staffing challenges with growing nursing shortages. And as the economy worsens, they may have to face declines in volume.
“In this economy we face the same challenges of any other business,” Ms Bryant says.
Kathy Bryant is president of the Alexandria, Va.-based Ambulatory Surgery Center Association (www.ascassociation.org), which counts more than 2,800 ASC members.
