DOJ task force, insurers target ASC barriers with parallel reforms

Editor's Note

Federal regulators and major insurers are independently moving to ease long-standing burdens on ambulatory surgery centers (ASCs), potentially reshaping the regulatory and administrative landscape in which perioperative leaders operate.

According to Ambulatory Surgery Center News June 23, ASC stakeholders are actively engaging with the new Anticompetitive Regulations Task Force of the Department of Justice (DOJ), which aims to eliminate laws that stifle market competition. Commenters from the ASC community have called for the removal of Certificate of Need (CON) laws that limit facility expansion and favor entrenched providers. One ASC professional likened the restrictions to McDonald’s needing permission from Wendy’s to open a new location. Others urged the task force to abolish Medicare’s inpatient-only list and reconsider burdensome programs like the mandatory OAS CAHPS survey, citing duplicative data collection and disproportionate strain on small facilities.

The Ambulatory Surgery Center Association (ASCA) submitted formal recommendations as well, as detailed in the article. Among its top requests: make it as simple to convert a hospital outpatient department (HOPD) into an ASC as the reverse, use the hospital market basket for ASC payment updates, and eliminate the ASC weight scalar. ASCA also pressed for more procedures to be added to the Medicare ASC Covered Procedures List, citing potential cost savings and improved access.

Separately, a group of leading insurers including Aetna, UnitedHealthcare, and Cigna pledged to streamline prior authorization practices, as reported by another Ambulatory Surgery Center News June 23 article. The voluntary reforms, organized by AHIP and the Blue Cross Blue Shield Association, aim to reduce delays and administrative load for providers. Key actions include implementing electronic prior authorization by 2027, narrowing the range of services that require approval, expanding real-time decisions, and ensuring physician review of denials. The initiative covers Medicare Advantage, Medicaid managed care, and commercial plans. Though not legally binding, officials from CMS and HHS expressed optimism that the changes would reduce waste and improve care continuity.

Taken together, these efforts reflect growing recognition across sectors that regulatory and administrative hurdles have hindered the efficiency and competitiveness of the ASC model—challenges that frontline perioperative teams are often left to manage.