Payment

One of the most significant, sector-shaping trends in health care is the migration of care out of the traditional hospital and into lower-cost outpatient settings. Ambulatory surgery center (ASC) market growth reflects this idea. In light of this overarching theme of care shifting into non-traditional settings, the ASC industry has entered into a period of rapid change and fast-paced growth that’s certain to extend into 2025. More private equity investors will turn their attention to … [Read more...]

In November, Kaiser Permanente announced it would require specific modifiers to identify anesthesia providers for reimbursement under its Washington health plans, causing alarm for ambulatory surgery center (ASC) operators and stakeholders, many of whom are struggling amid a national anesthesiologist shortage.  Additionally, the reimbursement rate for QZ services performed by Certified Registered Nurse Anesthetists (CRNAs) was to be reduced to 85% of the Physician Fee Schedule.  QZ is a … [Read more...]

Last year was a pivotal year for the ambulatory surgery center (ASC) industry, marked by transformative trends, groundbreaking innovations and high-stakes decisions that reshaped the landscape. It was also an exciting year for us at Ambulatory Surgery Center News, as we launched in the summer of 2024 with a mission to deliver in-depth reporting and actionable insights tailored to ASC operators, investors, payers, clinicians and other stakeholders. Since our debut, we've brought you stories … [Read more...]

Anthem Blue Cross Blue Shield wanted to cap anesthesia coverage after a certain point, meaning such services after a set threshold would not be reimbursed. That plan saw major blowback, with the American Society of Anesthesiologists in November calling for an immediate reversal. “Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the … [Read more...]

GLP-1s and Medicare Advantage (MA) are two potential headwinds for ambulatory surgery centers (ASCs), with each undoubtedly playing a larger role in 2025. Partly because of this increasingly prominent standing, the U.S. Centers for Medicare & Medicaid Service (CMS) proposed new policies related to both GLP-1s, or glucagon-like peptide-1s, and MA on Nov. 26. “This proposed rule includes more policies to remove unnecessary barriers to care stemming from the use of inappropriate prior … [Read more...]

You can often take the pulse of any industry by analyzing the words of its leaders. And while there were plenty of interesting quotes from ambulatory surgery center (ASC) leaders in our reporting this year, a few stood out for their thoughtfulness, candor and relevance. From pricing transparency and strategic partnerships, to navigating compliance and the growing shift towards high-acuity procedures, these quotes capture the essence of the challenges and opportunities facing ASCs … [Read more...]

The average facility fee for ASCs is significantly lower than for hospitals across a variety of  common outpatient procedures, which carries implications for policies such as certificate-of-need laws. That’s according to a recent study published in The American Journal of Managed Care which found that hospitals, on average, charge facility fees more than  twice as high as those negotiated by ASCs for the same procedures.  Hospital fees exceeded ASC fees by $3,077 on average, with mean … [Read more...]

The Centers for Medicare & Medicaid Services (CMS) has finalized 2025 Medicare payment rates and quality reporting program updates for ambulatory surgery centers (ASCs). ASC payment rates will increase 2.9% in CY 2025 for centers meeting relevant quality reporting requirements, according to a final rule that CMS issued Friday. The rule received backlash from industry stakeholders.  “This final rule is a step sideways in a time when millions of Medicare beneficiaries need CMS to advance … [Read more...]

Health care facilities in some of the nation’s largest markets have had to power through multiple natural disasters over the last couple months, including tropical storms, hurricanes and wildfires. Tenet Healthcare Corporation (NYSE: THC) is no exception. But considering recent events, the company has been “fortunate” in its ability to plan and recover, executives said during a 2024 third-quarter earnings call Tuesday. Despite weather-related setbacks, the Dallas-based Tenet still had a … [Read more...]

The Federal Reserve’s recent decision to cut interest rates by half a percentage point marks a shift in monetary policy, signaling that inflation is cooling and that the central bank may now be focused on keeping the labor market stable.  In turn, that could mean there’s more ambulatory surgery center (ASC) transaction activity on the horizon. “We’re trying to achieve a situation where we restore price stability without the kind of painful increase in unemployment that has come sometimes … [Read more...]