Image by cytis from PixabayThe federal government officially shut down on Oct. 1 after Congress failed to reach agreement on a short-term spending bill.
The immediate fallout will mean furloughs for hundreds of thousands of federal workers and stalled services across multiple agencies.
For ambulatory surgery centers (ASCs), the impact may not be as direct as it is for hospitals or other federally funded programs, but industry leaders say ripple effects could be on the horizon if Congress does not act soon.
“If Congress acts soon, the effects of a shutdown will be minimal on ASCs,” Kara Newbury, chief advocacy officer of the Ambulatory Surgery Center Association (ASCA), told ASC News in an email. “A lengthy government shutdown, however, could impact ASCs and our patients. If the shutdown persists, Medicare claims may be delayed, and CMS oversight of its Medicare Administrative Contractors will be limited. In addition, some survey activity, such as initial and recertification surveys will be delayed.”
A government shutdown occurs when Congress fails to pass appropriations bills or a continuing resolution to keep the government funded.
This year, Democrats in the Senate are demanding funding for health care subsidies under the Affordable Care Act, while President Trump and congressional Republicans have refused to include them in stopgap legislation. With neither side willing to compromise, the has government entered a funding lapse.
The longest in U.S. history stretched 35 days in 2018 and 2019 over funding for a border wall. The current standoff centers on health care costs, making it particularly relevant for surgery centers. Historically, shutdowns have lasted anywhere from a few days to several weeks.
While Medicare payments are considered mandatory spending and are not halted during a shutdown, surgery centers could still experience delays in reimbursement, ASCA said in a member memo.
With fewer CMS staff available to process claims, payments may take longer to arrive, which could put added pressure on facilities already operating with narrow margins.
“Furloughs within federal agencies could pause or delay important regulatory actions, including updates to the ASC-payable list, reimbursement policy changes and quality reporting processes. CMS surveys were also delayed during previous government shutdowns,” ASCA said.
Those kinds of disruptions can leave ASCs in payment limbo.
Another risk lies in patient access, ASCA wrote. The shutdown coincides with the expiration of enhanced subsidies under the Affordable Care Act, raising the possibility that patients could lose coverage altogether or see their premiums rise.
“Combined with the risk of Medicaid funding cuts, this could reduce patient access and lead to a decline in elective or non-urgent procedures – particularly in ASCs serving higher numbers of Medicaid or ACA exchange patients,” ASCA wrote.
Also of note for health care organizations: Oct. 1 was also the deadline to extend the Medicare telehealth flexibilities that have been in place since the COVID-19 public health emergency (PHE).
Now, telehealth flexibilities have expired for Medicare beneficiaries, apart from individuals being treated for mental health or substance use disorders (SUDs).
Additionally, Oct. 1 brought turmoil for hospital-at-home programs. Now, all patients receiving hospital care at home must be discharged to the hospital immediately, ASC News sister publication Home Health Care News reported.
