ADVOCACY SPOTLIGHT
to the productivity adjustments and sequestration, but certain sectors have also been hit by a variety of policy changes in the nearly annual Medicare bills that have passed since the enactment of the Affordable Care Act. Home health has been substantially cut through a “rebasing” of payments when cost
MedPAC termed “excessive Medicare margins.”
reports showed what As mentioned above,
hospitals and the post-acute sector have also been cut substantially. Most recently, Congress took note of the substantial payment windfalls hospitals experience when they acquire physician practices and ASCs by pro- hibiting those higher hospital pay- ments on future acquisitions. While ASCs certainly would have preferred to see our payments increased rather than
hospital payments decreased,
enactment of this policy in the Bipar- tisan Budget Act of 2015 underscored the fundamental point ASCs have been making about the value of a competi- tive delivery system that should not be controlled by sprawling mega-hospi- tals seeking to dominate care in cer- tain communities.
Looking forward to 2017, what policy challenges do you foresee in the industry? MCMANUS: We are in a very trans- formative period with the ongoing implementation of the Affordable Care Act—for example accountable care organizations continue to emerge and evolve—and now implementation of the new value-based physician pay- ment system under MACRA. There is a bipartisan consensus in the pol- icy community that bundled payments
and value-based care should replace a system that rewards volume, but get- ting to that goal will be difficult. The regulations implementing these laws will be complex and cumbersome and probably require corrective legisla- tion in the future. Lastly, we must recognize that Medicare and entitlement spending is driving budget deficits. Congress— whether controlled by Democrats or Republicans—will be seeking policies that constrain spending. Our mission is to show these policy makers that ASCs are part of the solution, not part of the problem, and that they need to put pol- icies in place that support ASCs.
Kristin Murphy is ASCA’s assistant director of legislative affairs. Write her at
kmurphy@ascassociation.org.
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