Reimbursement disparities have caused discord in the ASC sector — even before 2024's CMS cuts.

Centene, Humana and UnitedHealthcare have some of the lowest-rated Medicare Advantage plans for customer satisfaction in their markets, according to J.D. Power's annual Medicare Advantage Study, published Aug. 20.

The number of physicians working in private practice is shrinking, as consolidation and rising costs makes practicing independently less feasible. 

Matt Mazurek, MD, assistant professor of anesthesiologist at the New Haven-based Yale School of Medicine, joined Becker's, to discuss the Stark law issues he's keeping an eye on. 

The ongoing shift toward value-based payment models has left many healthcare executives weighing the pros and cons of the practice compared to more traditional fee-for-service models.

The Justice Department's new pilot program, which rewards whistleblowers who provide evidence of corporate misconduct, could lead to an uptick of whistleblower activity related to private payer fraud, The National Law Review reported Aug. 15

Most physicians expressed disapproval of relative value unit-based pay in Medscape's 2024 "Physicians and RVUs Report." 

On Aug. 1, CMS released the nearly 3,000-page final rules on reimbursement and other inpatient issues, according to an Aug. 7 blog post by Coronis Health. 

Differences in reimbursement between ASCs and HOPDs are an ongoing pain point for surgery centers. However, many opportunities to profit off of specialty procedures remain, regardless.

Physicians are eyeing Stark law as the Department of Justice doubles down on enforcement, with an uptick in complaints-in-intervention and Stark-related settlements. 

As of 2023, nearly half of U.S. hospital and health systems have at least one partnership, affiliation, or ownership interest in ASCs. Reports from industry publications indicate ASCs are becoming central to the overall financial strategy of extensive healthcare service networks and this trend is expected to accelerate due to three main factors: pressure to reduce costs, provide care for aging population, and adapt to changes in government regulation as more complex procedures are approved for outpatient environments.

More than 80% of surgeries are now performed in an outpatient setting, according to the Ambulatory Surgery Center Association.  ASC procedures are almost always less expensive than in hospital outpatient departments. 

The vertical integration of physician groups and health systems is resulting in a push to procedures to hospital outpatient departments over ASCs, driving Medicare and patient out-of-pocket costs up, according to a study published July 25 in Science Direct. 

ASCs are flourishing across the country, with payers, patients and health systems taking note of the cost-savings potentials.  

The average general surgeon billed commercial payers more than $11.6 million each year, according to an Aug. 1 analysis published by healthcare staffing firm AMN Healthcare.

A House committee in June unanimously advanced legislation that would make permanent an in-office ancillary services exception to Stark law for drugs provided under Medicare. 

ASCs in many markets are struggling to secure higher reimbursements and gain leverage in payer conversations. 

Here are 10 multimillion-dollar Stark law settlements Becker's has reported on in two years:

Charleen Tacket, administrator of Vital Heart & Vein in Houston, joined Becker's to discuss how patient experience is often missed in conversations with insurance companies. 

New Hampshire Gov. Chris Sununu has signed a law stating that certain physician assistants will no longer have to sign a "collaboration agreement" with a physician for their entire career, New Hampshire Bulletin reported July 30.