Prior authorizations stand as both a gatekeeper and a stumbling block for the ASC industry. These pre-approvals required by payers serve as a crucial step in ensuring the medical necessity of procedures while functioning as a cost-control mechanism. However, the journey from authorization request to approval is often challenging, particularly for orthopedic procedures.

Here is how the cost of four common ASC procedures has changed from 2019 to 2024, using data from  Blue Cross Blue Shield affiliate Blue Health Intelligence's "Rising Prices for Hospital Outpatient Care" brief, published last year and Sidecar Health's care calculator:

The Federal Trade Commission voted to ban noncompete clauses for most U.S. workers April 23. The rule would make it illegal to include noncompetes in employment contracts unless the employer is a nonprofit, as the FTC's jurisdiction does not generally cover tax-exempt organizations, according to an article by law firm Sheppard, Mullin, Richter & Hampton published April 30 in National Law Review. 

The Federal Trade Commission voted to ban noncompete clauses for most U.S. workers April 23, and organizations have begun to file lawsuits. 

Maryland Gov. Wes Moore has signed a law prohibiting noncompetes for healthcare professionals April 25, according to an article by labor law firm Littler published in JDSupra. 

Physician reimbursement amounts per Medicare patient decreased around 2.3% between 2005 and 2021 when accounting for inflation, according to a new study from the Harvey L. Neiman Health Policy Institute.

A physician from Sewell, N.J., was convicted for causing the submission of more than $5.4 million in fraudulent claims to Medicare.

Here are six recent moves by CMS that may benefit — or burden — ASCs, as reported by Becker's in 2024: 

ASCs are historically reimbursed at lower levels than hospital outpatient departments, despite being considered by many in healthcare to be a high-quality and low-cost site of care. 

The Federal Trade Commission has banned noncompete clauses for most U.S. workers, The Washington Post reported April 23. 

The Pennsylvania House has passed legislation that would ban noncompete clauses for  physicians, certified registered nurse practitioners and physician assistants.

The Federal Trade Commission will hold an open meeting to vote on its proposed noncompete ban April 23.

The manual prior authorization process stands as a notorious drain on both time and money. For ASCs, this aspect of the revenue cycle curtails efficiency but also strains staff resources, jeopardizing cash flow and overall financial success.

The American Medical Association backed the Medicare Payment Advisory Commission's recommendations for Congress to reform Medicare payments.

CMS settled a record-breaking $12.56 million in Stark law voluntary self-referral disclosure settlements in 2022, according to recent CMS data.

Physicians, state governments and the Federal Trade Commission are all battling to reform policy surrounding noncompete clauses, which prohibit physicians from seeing patients one to two years within a geographic region if they are fired or quit their job.

Noncompete clauses are facing increasing scrutiny, as physicians, states and even the Federal Trade Commission look to reform policy. 

Hospitals, health systems and physicians faced big Stark law penalties in 2023.

Patient and provider interest in ASCs is rising, but markets that have stringent certificate-of-need laws could struggle, leaders say. 

ASCs are becoming an increasingly popular site of service for patients, and payers are taking note.