As expected, the 2011 Texas Legislature was very active for the ASC industry. On the positive side, the Texas ASC Society initiated legislation that would have limited the state’s so-called “revenue code data collection program” for ASCs. The program, which collects revenue code data from hospitals and ASCs, has proven to be a tremendous burden on ASCs that has resulted in no safety or quality information for ASCs. We pushed efforts that would have greatly scaled back the reporting requirements. We were able to get it out of committee and into consideration during a conference report. We’ll continue working on this issue in the next two years.
Commercial insurance issues took center stage in the Legislature. As an industry, we were pleased to switch from being on the defense to going on the offensive and pushing some important commercial insurance concepts for the ASC industry. We initiated legislation that would require commercial insurance plans to use usual and customary standards based on usual and customary rates when developing ASC rates. Specifically, we took a long look at the possibility of using FAIR Health Inc. as the centerpiece of this initiative. We were pleased to get this out of the House Insurance Committee. This will continue to be an issue for us to push.
Some issues from the 2011 Legislature led to a bit of uncertainty that will require our work in the stakeholder process. In particular, two of issues will result in tighter provider networks. A commercial insurance plan was successful in passing a new type of insurance, exclusive provider organization benefit plan, which resembles a PPO with no out-of-network options. In addition, the Legislature was not able to get the state’s health insurance exchange passed. So we’ll continue watching that.
Q: What do you think the organization has accomplished since you took it over in 2008?
BH: When I took this job in 2008, I reflected on the fact that I had only met two people from the ASC industry in my seven years of working as a healthcare aide on Capitol Hill. I would not have been able to have told you very much about the industry. This was evidence to me that we needed to elevate our profile among policymakers and the healthcare industry. But this couldn’t happen without first educating our grassroots base, the ASCs, about the political process and how to be active.
We spent a lot of time enhancing our communications to ASCs. This allowed us to educate ASCs about what to expect in the political process and how government actions were impacting their business. Since that time, our membership has increased by over 100 percent. I believe that the huge membership increase is a direct result of our emphasis on communicating with the industry. It has been amazing to see how hungry the industry is for timely information about policy and industry matters.
Once we were able to get that huge grassroots network in place, we were ready to start targeting policymakers and other segments of the health care industry. Today, the Texas ASC Society has a stakeholder seat at the table with the hospital, medical and insurance trade associations. These trade groups and policymakers recognize the huge impact of the ASC industry.
Q: What are the top issues facing your members?
BH: Each Texas city has a different healthcare market. So you will see a lot of issues throughout the state. But declining commercial insurance rates tend to the biggest concern in every city. A lot of the larger cities in Texas are seeing problems with non-compete issues.
Q: What will the Texas ASC Society be working on in 2012 and in the future?
BH: Now that we have built up a strong grassroots membership and secured a stakeholder seat at the healthcare table, it’s time for us take the Texas ASC Society to the next level. In 2012, we’ll be rolling out our “Operation ASC Open House” program. This will be our industry’s PR effort that will focus on two key audiences: policymakers (lawmakers and regulators) and other segments of the healthcare industry. The goal will be for us to promote the ASC industry to these targets.
Instead of just doing a generic PR outreach to the general public, we think that it is more important to focus a targeted PR effort on those entities that have the greatest impact on ASCs — policymakers and the rest of the healthcare world.
We have made great inroads with lawmakers and regulators in Texas. We will continue building on those relationships with visits to ASCs and telling our story about how ASCs can benefit the state’s public health plans, such as the Teacher Retirement System of Texas. In addition, we’ll talk about usual and customary standards and how they can benefit their constituents.
I think that our industry has an untapped opportunity for our industry to sit down with employer-based plans, HR consultants and commercial insurance plans to talk about why ASCs are valuable to their products. The California ASC Association has been doing this for quite a few years. Blue Shield of California recently released materials for employers that promote ASC use.
I think that this shows what can happen when our industry tells our story. Much like me working on Capitol Hill and rarely hearing from the industry, I think that the employer-based plans, HR consultants and commercial insurance plans need to hear from us.
Q: What is your future vision for the Texas ASC Society?
BH: In an ideal world, every physician who is part of an ASC would be politically active. With thousands of physicians, the ASC industry has an opportunity to be a tremendous force in the political process. So we have to keep getting our message out to administrators and physicians about the importance of their being involved in the political process.
I don’t think that we ever want to be in a position where a legislative aide in Washington or Austin who has covered healthcare for seven years has never heard from their ASCs. When it’s time for a policymaker to make a legislative or regulatory decision that impacts ASCs, we want them to know the ASCs in their district. And we want all of the other medical societies, hospital associations and commercial insurance plans to fully understand the ASC story.
From a personal standpoint, I think that it would be great if our state association could create a more formal partnership with the ASC Association. It’s amazing to see what kind of an impact Bill Prentice, Steve Miller and their team have made in Washington. It shows what can happen when an industry comes together.
Learn more about the Texas Ambulatory Surgery Center Society.
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