Five Stats making ASC Healthcare execs nervous

As I have said before, I get many things in my In-Box. Beckers Healthcare ASC News Review is one of them. If you do not know what an ASC is, I have included a definition. U of M Hospital has a few of the around Ann Arbor.

Ambulatory Surgery Center = modern health care facilities focused on providing same-day surgical care, including diagnostic and preventive procedures.

The stats in this news clip I thought were interesting enough to post separately rather than in a news roundup.

“5 statistics making ASC execs nervous,” beckersasc.com, Patsy Newitt.

With rising operation costs, nurse shortages and a push toward industry consolidation, independent physicians and ASCs are having a hard time staying independent. 

Five stats reflecting challenges ahead for ASC owners and operators:

• 13 million: Global shortage of nurses predicted by 2030 without sufficient recruitment and retention, according to a January report from the International Centre for Nurse Migration.

• 79 percent: Percent of medical groups said that payer prior authorization requirements increased in the last year, according to a March poll conducted by the Medical Group Mgt. Association. A March 1, 2022, MGMA Stat poll asked medical groups: “How did payer prior authorization requirements change in the past 12 months?” Seventy-nine percent answered “increased,” 19% said “stayed the same,” and only 2% remarked they “decreased.”

• 108,700: Number of formerly independent physicians who are now employed by hospitals, private equity firms, insurers or other corporate entities, according to a report from Avalere. 

• $2.2 million: Amount surgery centers spent on employee salary and wages, about 21.3 percent of net revenue, according to the VMG Health “Multi-Specialty ASC Benchmarking Study.”

• 57 percent: Percent of U.S. small-business owners expecting economic conditions to worsen in the next year, according to a May survey conducted by the Wall Street Journal, a number equivalent to the all-time low recorded in April 2020.

We were at the dentist recently. Our insurance rejected a claim. I thought it might be wording. The front desk claims insurance is questioning greater numbers of treatments. They believe the people reviewing just don’t know. Also, many of the complaints about Medicare Advantage focuses on authorization rejection. MA reviews patients each year and pricing is set. Not treating patients is one way to be more profitable as they still keep the funds. Over coding is a practice also. Coding differences increased Payments to MA plans by $12 billion in 2020, (page 439).

Ok, this is at the business level. How does this boil down to patients?

With fewer entities having greater control of services, pricing to patients will increase. Shortage of personnel or nurses is an issue. This will fall more on rural areas than the more affluent area. The consolidation of doctors under fewer organizations leads to high pricing and greater profits to the organization. We are seeing this happen with ER staffing. The rejection of claims or preauthorization is a feature and not a bug. This purposeful delay and denial of healthcare services. This is being seen in Medicare Advantage.

The hell with the execs. These issues portend greater problems for the insured and uninsured in care and costs.

“Payer prior authorization requirements aren’t improving,” mgma.com, Claire Ernst

“50 stats on ASC staffing costs,” beckersasc.com, Patsy Newitt

“The Medicare Advantage program: Status report and mandated report on dual eligible special needs plans,”Report to the Congress.

“Discussions on Healthcare Topics,” Angry Bear, angry, bear, blog