Ride along with Mark as he discusses the settlement by Sutter Health and a cardiac surgery group involving allegations that exclusive contracts, coverage stipends, and medical director fees were kickbacks to reward referrals. Avoid the same fate.
Ride along with Mark as he discusses a question you might have never asked yourself: Who actually owns your medical group? It might not be who you think it is.
Yes, 4.89 billion reasons for you, if you are a physician who owns or is thinking about owning a surgery center (“ASC”). And, yes, each of them is green. Green as in a dollar bill.
That’s the dollar amount that the Centers for Medicare and Medicaid Services (“CMS”) estimates it will be paying ASCs in 2019. That sum includes an approximately $300 million increase to ASCs, many of which are physician owned. That might include the ASC that you’ve been thinking of forming.
Thinking’s fine, but action’s better.
In addition to those 4.89 billion reasons, there are a few other incredibly interesting bullet points to note in regard to CMS’s proposed 2019 payment rules for ASCs:
• Reimbursement to ASCs will increase, on average, by approximately 2%.
• CMS added a total of 183 new codes to the list of procedures approved for ASC payment.
• 45 “surgery-like” procedures will be added to the covered list.
• On the interventional surgery front, 12 additional cardiac catheterization procedures will be added to the ASC approved payment list.
• And, very interestingly, instead of the historically applied, more general CPI-based adjustment formula, CMS is proposing to use the same “market basket” approach it uses to adjust hospital outpatient department (“HOPD”) rates in connection with 2019 payments, forward.
As the future of surgery moves from the hospital setting to the outpatient setting, ASC’s are where the action is. Hospitals, and, increasingly, HOPDs, are where the action was.
Don’t be left behind.
The time is now to consider how you can legally profit from ASC ownership.
Look at it like this: You can finally say goodbye to all those folks in suits who have their hands in your pockets.
[Note: The idea for this post was suggested by Cecilia Kronawitter of HDA Enterprises, one of the most experienced ASC developers in the country. Cecilia can be reached at email@example.com.]
Comment or contact me if you’d like to discuss this post.
Mark F. Weiss