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How Dr. Oz and Robert F. Kennedy Jr.'s Medicare and Medicaid Stances Can Benefit ASCs

Writer's picture: Emily SpoonerEmily Spooner


The healthcare landscape in the U.S. is poised for significant shifts with the recent appointments of Dr. Mehmet Oz to lead the Centers for Medicare & Medicaid Services (CMS) and Robert F. Kennedy Jr. to head the Department of Health and Human Services (HHS). Their respective approaches to Medicare and Medicaid have the potential to bring about changes that could directly benefit ASCs. ASCs, which provide cost-effective, high-quality care, could see both challenges and opportunities from these new appointments. Here’s how the healthcare policies proposed by Dr. Oz and Mr. Kennedy may impact ASCs, and how these shifts could prove beneficial for your center.


Dr. Oz’s Support for Medicare Advantage


Dr. Oz has been a vocal advocate for expanding Medicare Advantage (MA) as a solution to the challenges facing the U.S. healthcare system. During his 2022 Senate campaign, Dr. Oz proposed expanding Medicare Advantage plans to all Americans who choose them, a plan called "Medicare Advantage Plus." This vision could have significant implications for ASCs, particularly if MA plans become more widespread.


Medicare Advantage plans often reimburse at higher rates for outpatient services compared to traditional Medicare, making them a benefit for ASCs. If the availability of these plans expands under Dr. Oz’s leadership at CMS, ASCs could see an increase in patient volumes, as more Medicare-eligible individuals would be able to access services in outpatient settings. This is especially important for ASCs, as they typically provide lower-cost alternatives to hospital-based care, which could help reduce the overall financial burden on the healthcare system.


Additionally, Dr. Oz’s focus on moving away from traditional Medicare’s fee-for-service structure towards a model that includes capitation (fixed payments per patient) aligns with the operational needs of ASCs. Under a capitation-based system, ASCs would receive predictable, lump-sum payments for the care of each patient, reducing the uncertainty and administrative burden associated with fee-for-service reimbursements. This shift could create more financial stability for ASCs and incentivize them to provide high-quality, cost-effective care, further aligning with the goals of the healthcare system.


Robert F. Kennedy Jr.’s Focus on Public Health and Medicaid Could Benefit ASCs


While Robert F. Kennedy Jr.'s position on Medicare and Medicaid has been less clearly defined, his approach to healthcare policy could still have a substantial impact on ASCs, particularly when it comes to Medicaid. Historically, Medicaid has been a challenging area for ASCs due to lower reimbursement rates and complex bureaucratic processes. If Kennedy prioritizes expanding access to care and improving public health under his leadership at HHS, ASCs may benefit from potential reforms aimed at enhancing Medicaid's efficiency and accessibility.


Kennedy’s reputation for focusing on scientific integrity and public health may lead to increased attention on improving Medicaid, potentially resulting in better reimbursement rates and streamlined processes for ASCs that care for Medicaid patients. If Medicaid policy shifts towards value-based care models, ASCs could see an increase in reimbursements for certain procedures, allowing them to continue providing high-quality care to underserved populations.


Furthermore, Kennedy's leadership could push for more funding and better administrative frameworks that allow ASCs to work more effectively with Medicaid. Efforts to reduce waste and inefficiencies in Medicaid could result in higher payment rates for outpatient procedures, ultimately benefiting ASCs that rely on Medicaid reimbursement for a substantial portion of their patient base.


Benefits of Expanded Medicare Advantage Plans


If Dr. Oz’s vision of expanding Medicare Advantage to all who want it comes to fruition, ASCs stand to benefit from the growing pool of patients eligible for these plans. Medicare Advantage is already known for offering more attractive reimbursement rates for outpatient procedures compared to traditional Medicare. This would help alleviate some of the financial pressures that ASCs face due to rising operational costs, such as staffing and supply expenses.


Additionally, Medicare Advantage plans typically offer more flexibility and are often better suited to outpatient care, which is where ASCs excel. As more Medicare beneficiaries opt for these plans, ASCs could experience higher patient volumes, greater financial stability, and an opportunity to expand services in a more predictable reimbursement environment.


Impact on Medicaid and ASC Financial Stability


If Robert F. Kennedy Jr. focuses on improving Medicaid, especially with a focus on efficiency and value-based care, ASCs could benefit from a more streamlined and sustainable Medicaid program. Historically, ASCs have faced challenges when it comes to Medicaid, including low reimbursement rates and complex administrative processes. If Kennedy’s leadership leads to Medicaid reforms that make payments more consistent and align with the cost-saving, value-driven model that ASCs advocate for, ASCs could see a significant boost in their financial sustainability.

Moreover, as Kennedy may focus on scientific evidence and improving public health infrastructure, his policies could increase funding for critical areas like preventive care, which often involves outpatient services provided by ASCs. These shifts would align with ASC’s goals of offering cost-effective procedures in a more efficient, patient-centered setting.


Potential for Collaboration Between Dr. Oz and Mr. Kennedy Jr.


The combination of Dr. Oz’s focus on expanding Medicare Advantage and Mr. Kennedy’s potential influence over public health initiatives could be a powerful force for ASCs. If both leaders work together to streamline healthcare delivery through reforms to Medicare, Medicaid, and value-based care, ASCs could find themselves at the forefront of a more efficient, cost-effective healthcare system.


By making outpatient care more accessible and reimbursing ASCs at higher rates, Dr. Oz and Mr. Kennedy could help foster a healthcare ecosystem where ASCs thrive. With the right policy changes, ASCs could see improved reimbursement rates, increased patient volumes, and more opportunities to provide high-quality, affordable care to a larger segment of the population.


How Marisa Consulting Can Help ASCs Navigate These Changes


At Marisa Consulting, we understand the challenges and opportunities that healthcare policy shifts can bring to ASCs. With Dr. Oz’s leadership at CMS and Robert F. Kennedy Jr.’s potential focus on public health, it’s crucial for ASCs to stay ahead of policy changes that could impact reimbursement and operations.


Marisa Consulting offers expert guidance to help ASCs navigate the evolving healthcare landscape. We specialize in optimizing revenue cycle management, streamlining payer negotiations, and maximizing reimbursement strategies, ensuring your center remains financially sound as the healthcare system transforms. Our team is ready to help you take advantage of new opportunities presented by changes to Medicare and Medicaid policies, allowing your ASC to thrive in a competitive, value-driven healthcare environment.


If you’re ready to position your ASC for success under these potential changes, contact Marisa Consulting today to learn how we can support your growth and financial stability.

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