As we delve into the new year, now is a good time for surgical facilities to look ahead to the upcoming top trends facing the ASC industry.

With the pandemic, ASCs across the U.S. have experienced temporary closures, case drops, and then ramp-up and recovery.

ASCs have reported a 30 percent or more revenue drop, with many reporting more than 50 percent revenue decline.

Since 2021 arrived, forward-looking ASC leaders are now preparing their teams for what could come next.

Despite challenges brought on by the pandemic, the outlook for ASCs is bright.

CMS Outpatient Payment Rule for 2021

CMS finalized the Outpatient Prospective Payment System and ASC Payment System final rule on Dec. 2. Here are some takeaways to the 1,312-page final rule:

On average across all covered procedures, ASCs will see a payment rate update of 2.4 percent. The final update applies to ASCs meeting relevant quality reporting requirements. The update rate for specific codes and specialties, however, may vary significantly.

Under the revised criteria for adding procedures to the ASC-payable list, CMS will also include 267 surgical procedures in 2021.

The public will also be able to suggest future additions to the ASC-covered procedures list (CPL) under a new notification process CMS is establishing.

When the final rules took effect Jan. 1, 2021, CMS began  eliminating the inpatient-only list by removing 298 primarily musculoskeletal-related services.

By calendar year 2024, the full list of 1,700 procedures will be completely phased out and approved for payment in the outpatient setting when clinically appropriate.

Staff Safety Becomes Top Priority

Right now, ASCs are prioritizing the safety of patients and staff by following the latest pandemic guidelines.

ASCs will continue to follow measures and leverage technology to keep patients and staff safe from COVID-19 exposure in 2021. A single positive case among employees could quickly put others in isolation.

In a worst-case scenario, understaffed surgery centers would have to cancel cases or temporarily close.

This is why many ASC leaders have used the pandemic to drill down policies and focus on the safety of patients and staff.

Many ASCs have created healthcare screeners and put in extra effort in infection control, screening, and sanitizing during the pandemic.

Surgery centers have also used technologies like contactless payments, telemedicine, and online patient scheduling not just for efficiency but for safety. One benefit in doing this is that surgical facilities will be able to highlight the cost, efficiency and safety of procedures performed at their centers.

ASCs Become the Preferred Site for Outpatient Surgical Procedures

The movement of outpatient procedures to ASCs has been going on for a while, but the pandemic has accelerated that.

Higher acuity case volume will continue to shift from the inpatient setting, further cementing the ASC as the low-cost, efficient alternative to the hospital setting.

Due to the pandemic, more patients, payers and physicians recognize outpatient surgery centers as the most desirable setting for quality care.

There’s a real awareness and demand amongst patients as they perceive hospitals as potentially risky.

With ASCs, patients get their surgery at a site that studies have shown to be safer and for a third of the price.

The COVID situation has really accelerated and driven demand to the ASCs.

After reaping these benefits with procedures done at ASCs during the pandemic, more patients are expected to request treatment at surgery centers in the future.

In 2021, it is expected that patients will routinely request to have their surgeries done in ASCs rather than in hospitals.

Patient Payment Plans Would Be More Common

The increasing healthcare financial responsibility being shifted to patients is giving rise to new financing models for ASCs.

Many patients have voiced economic concerns related to their surgery. This could provide ample opportunity for ASCs to develop more robust financial planning capabilities for their patients.

With many people experiencing financial strain now due to the pandemic, patient payment plans are becoming more common.

Patient payment plans can increase patient propensity to pay by distributing large deductible and coinsurance costs into affordable installments over time.

Proactive surgical facilities would identify a patient’s current financial situation and engage them with personalized payment plan offers pre- and post-service. This would enable patients to self-activate payment arrangements that meet their needs.

As ASCs would rather focus on their core competencies of providing high-quality outpatient surgical care, we would see many surgery centers partner with third-party RCM vendors to take the risk of self-pay patients.

In 2021, we will be seeing more third-party organizations paying the ASC for the patient’s responsibility. The third party then takes on the responsibility of collecting the balance from the patient.

Leveling of the Playing Field Between ASCs and Hospital Outpatient Departments

There’s a wide reimbursement gap between ASCs and hospital outpatient departments (HOPDs).

Since CMS didn’t address this gap in its final rule for 2021, ASCs will continue fighting to eliminate the differential.

The 2020 election saw some losses of ASCs’ long-time champions in the House. But almost 90 percent of ASC supporters have retained their seats including the sponsors and original cosponsor of the Ambulatory Surgery Center Quality and Access Act of 2019.

The Ambulatory Surgical Center Quality and Access Act of 2019 seeks to modernize payments for ambulatory surgical centers under the Medicare program. Its provisions would enact a series of reforms aimed at leveling the playing field between ASCs and hospital outpatient departments (HOPDs).

These reforms include updating reimbursement for ASC services using the same update factor as HOPDs and adding an ASC representative to the Advisory Panel on Hospital Outpatient Payment.


About Mnet Health

We believe every patient deserves a helpful, transparent, easy to navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. We provide custom patient-pay solutions to surgical hospitals and ambulatory surgery centers. As of 2020, Mnet Health partners with over 700 surgical facilities nationwide and is the preferred vendor of both United Surgical Partners International (USPI) and Surgical Care Affiliates (SCA) – both directly with and in support of centralized billing offices.

Mnet’s custom brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit https://mnethealth.com.