MEDICARE MONITOR
Volatile Times for ASCs More changes to the health care system are likely as the debate continues. BY JONATHAN BEAL
T
he debate over the future of the nation’s health care system is continuing to take center stage. Rather than resolving the issue, this summer’s Supreme Court decision upholding the Affordable Care Act’s (ACA) central provisions intensified skirmishes over how the law will be implemented and added fuel to the debate over whether the law should be repealed or remain on the books. Moreover, some form of Medicare re- form appears to be on the horizon. As this article goes to press, the results of the November elections are unknown. It seems unlikely, how- ever, that the elections, regardless of which political party prevails, will do much to move health care from its position at the center of the nation’s policy debate, nor will they do much to settle the question about what the future of the nation’s health care sys- tem will be. Instead, it seems likely that aca- demics, special interest groups and policy makers will continue to spend much of their time debating the matter. And the looming specter of unsustainable Medicare spending makes it almost certain that the fu- ture of Medicare will be at the center of these battles. Our nation’s focus on health care, including the Medicare program and the volatility caused
by differing
opinions among those driving the de- bate, means two things for the ASC community. First, it provides fertile ground for policies and ideas that could have an impact on how ASCs operate, and second, it underscores the importance of ASC engagement in the public policy debate. When a public policy issue be- comes the focus of the nation’s col-
lective attention, it naturally results in robust engagement by academics, stakeholders and policy makers. This engagement fosters
changes that
can affect ASCs in significant ways. Some changes can be positive, like a provision in the ACA that waives cost sharing for colonoscopies. Oth- ers can be negative. For example, the ACA also contains a provision that effectively prevents new physi- cian-owned hospitals from opening. While that particular provision does not affect ASCs directly, it demon- strates skepticism about physician ownership of health facilities. Some changes, while broad, are
more ambiguous. The idea of account- able care organizations, which began as the brainchild of prominent health policy academic Elliot Fisher and was incorporated into the ACA, aims to reshape how providers are paid by re- warding providers for lowering costs while meeting quality benchmarks. It
lematic change was not made out of malice but out of ignorance of the fact that some ASCs routinely per- form same-day services. Still, once the change was finalized, its undo- ing took several years and a great deal of effort. Any changes to the nation’s health care system, regardless of their char- acter, are more likely to occur during a time when the future of health care is at the center of the national discussion. And once the window of debate has closed, additional change becomes less likely as academics, interest groups and policy makers turn their attention to other matters. With the ongoing debate over
the ACA, specifically, and health care reform, generally, and with an inevitable debate over the future of Medicare, it is not being hyperbolic to say that these are the most volatile times for health care policy since the Medicare program was established in the 1960s. Decisions that are made over the next few years will affect how health care is provided for years to come.
Any changes to the nation’s health care system, regardless of their character, are more likely to occur during a time when the future of health care is at the center of the national discussion.”
remains to be seen, however, how far- reaching the results will be. Changes in public policy can also lead to unintended consequences. When the Centers for Medicare & Medicaid Services substantially re- vised its Conditions for Coverage, it used language that effectively out- lawed ASCs from performing cases on the same day they were sched- uled. By all accounts, that prob-
22 ASC FOCUS NOVEMBER/DECEMBER 2012
If those involved with ASCs want ASCs to continue to thrive in the fu- ture, they must become engaged now. The process of changing our nation’s health care system is in full swing, and if ASCs want to continue to play a role, staying on the sidelines is no longer an option. For informa- tion about ways that you can become involved, contact Steve Miller at
smiller@ascassociation.org.
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