2017 is shaping up to be a particularly interesting year in healthcare, one that will likely be full of uncertainty but also opportunity. This extends to the ambulatory surgery center (ASC) industry.
There are numerous trends that could affect ASCs this year, and, subsequently, their bottom line. Here are 10 revenue cycle trends and developments for ASCs to watch.
1. Future of the ACA. The Affordable Care Act (ACA) became a political football in the 2016 election, with the president-elect promising to dismantle the program when he assumes office.
2. New HHS secretary's ASC history. Tom Price (GA-R), the president-elect's choice to serve as the next head of the Department of Health and Human Services (HHS), may be a name that is familiar to many ASCs.
3. Increased migration of procedures to ASCs. A trend for a number of years now, procedures are increasingly leaving the inpatient setting for lower-cost, higher-quality settings, such as ASCs.
4. More device-intensive procedures. Some of the more complex procedures migrating to the outpatient setting, such as those in orthopedics and spine, require the use of implants, and usually expensive ones.
5. Payer use of claims auto-adjudication. Payers are increasingly implementing this process in an effort to lower healthcare costs.
6. Crackdown on fraud. Since 2007, Medicare Fraud Strike Force teams have charged more than 2,300 defendants with defrauding Medicare of more than $7 billion and convicted approximately 1,800 defendants of felony healthcare fraud offenses, according to the U.S. Department of Health & Human Services.
7. Continued focus on bundled payments. As reimbursement gradually shifts from reimbursement based on fee-for-service toward pay-for-performance as part of the increased emphasis on value-based care, one payment method receiving some of the most attention is bundled payments.
8. Growth in joint ventures between ASCs and hospitals. It wasn't long ago that hospitals were actively trying to halt or at least stunt the growth of ASCs.
9. Health plan mergers. Over the past few years, there has been an increase in health plan consolidation, which has reduced competition between payers and, in some markets, severely limited the number of potential payer partners for ASCs.
10. Health plan and ASC mergers. On January 9, it was announced that OptumCare, UnitedHealth Group's health-services arm, had agreed to acquire Surgical Care Affiliates (SCA).