CMS 2025 Final Payment Rule Impact On ASCs w/ Michael McClain

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. And today we are joined once again by Michael McClain. Michael is the founder of Left Coast Healthcare Advisors. He’s got over 20 years experience in healthcare, including time as a hospitalist PA, and he’s helped leadership roles in large and small healthcare organizations alike.

Erik Sunset: I’m sure you’ve seen him around. He’s also a nationally recognized speaker and frequent contributor in the ASC space. Michael, thanks for joining us again.

Michael McClain: Thanks, as always, for having me, Erik. I love being on your show.

Erik Sunset: It’s our pleasure, and I was sorry that, uh, I didn’t get to spend some time with you in person in Tulalip, Washington last week for, uh, for Waska. I heard some good things about the event. How did it treat you?

Michael McClain: You know, we had a great time, uh, had a great time hanging out with your DocBuddy folks. It’s always good to come to our Waska conference. It’s local. It’s our people. We had a great time.

Erik Sunset: It’s, uh, it’s fitting. Left coast, for those that didn’t connect the dots. Left coast, west coast, and [00:01:00] Tulalip is way out there. And today we have a very sort of singular point of discussion and that is around the CMS 2025 final payment rule. Obviously impacts to providers, impacts to the ASC. I don’t think I’m talking out of class here if I say that early reactions were less than positive, bordering on negative, and there’s a lot to unpack there.

Erik Sunset: What are you seeing there, Michael?

Michael McClain: Yeah, you know, I, I think probably the, I think probably the best, uh, most politically appropriate response came from Bill Prentiss of ASCA, which was that this represented a step sideways, um, meaning not progressive, not forward thinking. Not entirely backwards, uh, but really out of step with what’s happening in health care and [00:02:00] clearly nothing truly beneficial for the ASE industry as it stands.

Michael McClain: And I think that this is sort of continuing a trend we’ve seen. over the last couple of years for ASCs, uh, which is Medicare continuing to sort of miss the mark and the value that our ASCs potentially have for Medicare beneficiaries and the role that they play in, in being able to truly improve access and lower the cost of care.

Michael McClain: Uh, I think it’s an opportunity that Medicare has, uh, that they continue to squander by just not understanding the role that ASCs play.

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Erik Sunset: Well, right before we started to record, we’re, uh, we’re in agreeance here. You know, we fly the ASCA flag, uh, high and proud here at DocBuddy, just like yourself. Uh, the ASC is really the only venue of care in America where everybody comes out ahead, the patient, the provider, um, and even the payer who’s so often forgotten about.

Erik Sunset: So when you look at this 2025, uh, final payment rule, What were some of the key misses you think to continue to advance the cause of the ASC?

Michael McClain: Yeah, I think I think there were several. Um, you know, I think the first and most obvious one is just the reimbursement. Um, you know, when you recognize that the total reimbursement was somewhere in the neighborhood of between 2 and 3 percent of an increase. Um, at, you know, uh, what we all recognize has been an unprecedented [00:04:00] increase in inflation, labor costs, supply costs, anesthesia costs.

Michael McClain: Uh, the fact that such a small increase in reimbursement was provided, uh, I think that alone tells you that that’s not keeping up with the with inflation, let alone the actual cost to provide services. And so that one right away sort of hits hard. It gets worse when you really look at the other side of the equation, which is the physician reimbursement side, where in multiple specialties on the professional reimbursement for anesthesia, For surgeons, many of the reimbursement categories, anesthesia is one of the most obvious that was hit hard with further reductions in reimbursement.

Michael McClain: So we are already struggling in the ASC space identifying anesthesia providers and being able to keep up with anesthesia costs, this is going to further [00:05:00] exacerbate that. So decreasing and professional comp with an increased pressure on ASCs because we’re not getting more reimbursement for our procedures.

Michael McClain: Um, so you take that as the double whammy. I think the third area though, that is probably the most disappointing is that Medicare has continued to really, Avoid being a progressive payer. You look backwards three to five years, and we spent, uh, you know, an early, uh, a joyful year, you know, back. And I want to say it was 2000.

Michael McClain: Uh, it was either 2022 2021. It was in that neighborhood where many of the, uh. Uh, IPO cases were removed where the inpatient only procedure list was essentially terminated for ASCs and it allowed decision making to occur where it should, which is with physicians and physicians being able to, to determine what are the most appropriate cases to be in an outpatient setting.

Michael McClain: Um, the inpatient [00:06:00] only list was reinstated and since that time we’ve had very little progress. And. in sort of moving those cases from an inpatient to an outpatient place of service. Now the reality is we understand and you know, I’m a clinician and I advocate for patient safety first. There should be a tiered model of care.

Michael McClain: There should be cases that are only done in the hospital setting, inpatient only. They’re critical cases. They need to stay overnight for a number of days. There’s sort of a secondary tier of cases, what I would call hospital outpatient cases. They may stay overnight. They need more critical support. They need more nursing support, more intensive care.

Michael McClain: Um, And that third tier of ambulatory surgery, ASC, uh, capable of being done in ASC, but that needs to be a sort of fluid environment and surgeons and nurses are the ones that should be making those decisions, not administrators and [00:07:00] insurance providers. And we’re just not able to do that with this Medicare model.

Michael McClain: And honestly, there are lots more procedures that, that even commercial payers are much more progressive about whether it’s cardiovascular services, more enhanced orthopedic or spine surgeon, uh, surgeries, those procedures are happening because commercial payers understand. The value we’re just not seeing medicare move the needle and that’s further contributing Actually to an inappropriate spend by medicare So it’s it’s that combination has just been awful

Erik Sunset: Well, and to your point about, uh, surgeon and nurse and care team sort of decision making, we had a fantastic guest, uh, not too long ago, Dr. Dan Blumenthal, who’s the chief quality officer of CVA USA. And he said a lot of the same things that you do. There are certain cases that are not appropriate for any other setting of care other than in the [00:08:00] hospital.

Erik Sunset: And then you can look at a Joe PD or hospital outpatient department type procedures, but for the right patient, you know, if it makes sense to do in the ASC, I want them to be able to go home the same day. I want to do that procedure in the ASC. So who wins when there’s this much bureaucracy and this much red tape of saying, you know what, we don’t really care what the surgeon thinks or what the facility is capable of, uh, of handling, you know, it’s going to happen in the hospital or it’s not going to happen at all.

Erik Sunset: Who, who comes out ahead when that’s the scenario?

Michael McClain: You know, what’s funny is, um, for years I blamed hospitals. Um, you know, for years I said, Oh, it’s, it’s the evil hospital lobby. Um, you know, they’re the ones that are, are claiming the value and the benefit here. Um, and then I spent a number of years working as a hospital executive over ambulatory service models.

Michael McClain: And, you know, To some extent, um, hospitals do have a little bit of gain. Um, and it’s because their payment [00:09:00] systems over the years, uh, have been built around some of the lower acuity cases, uh, that they get reimbursed considerably higher for. If you look at the ASC versus HOPE reimbursement models, even at Medicare, hospitals tend to be paid almost double what they should be.

Michael McClain: Uh, an ASC is paid for the same procedure on a Medicare fee schedule and that can be even a larger delta, uh, when you talk about commercial reimbursement, what’s ironic though is that model is maintained by the payer industry and it’s, it’s the payer industry that continues to refuse to reimburse hospitals for their most complex cases and instead continues to reimburse them for those lower acuity cases rather than reimburse them for the higher higher acuity cases.

Michael McClain: So it’s almost as if the system of third party payers and hospitals continues to [00:10:00] perpetuate this system, uh, that forces lower acuity cases. Uh, to stay in a hospital setting because if hospitals move that volume to another location, they’re not getting the benefit of payers reimbursing them more for the higher acuity cases.

Michael McClain: The payers simply pocket the difference. So there’s this complex dance that’s occurring in the middle. So I think the only people who are benefiting right now, in my opinion, are the third party payers. that every time a case moves to an ASC. And we’re seeing this pressure on the commercial side. We’re not seeing an increase in commercial reimbursement for ASCs.

Michael McClain: In fact, we’re seeing downward pressure on ASCs. I think the only party that’s benefiting right now is the third party payers from the infighting between ASCs and hospitals.

Erik Sunset: What a shame to lose out on that venue of care for bureaucracy. Um, I don’t know any other way to phrase it.[00:11:00]

Michael McClain: That, I think that’s a great way to phrase it.

Erik Sunset: And to go back to your second point around anesthesia, um, that is a specialty that is We’re already experiencing a shortage of anesthesiologists. You see certain states lifting the prohibition on CRNAs, providing their services without anesthesiologist oversight. To go macro, you know, zoom all the way out here, you know, if you’re taking a specialty where you already don’t have enough of that type of provider, And now per this 2025 final payment rule, you’re going to reimburse them less.

Erik Sunset: What’s the fix? How do you introduce more anesthesiologists or CRNAs into this system?

Michael McClain: Well, you know, what’s, if, if I may, I’ll take it even one step further than that. Uh, if you look at anesthesia programs nationwide, uh, uh, I recently read an article, I believe it was in Becker’s, although it may have been, [00:12:00] uh, it may have been in another, uh, health care, uh, venue, is that, uh, Anesthesia is under matching, meaning there’s more anesthesia applicants for residency than there are residencies because we don’t have enough training programs to match all those interested in going into anesthesia.

Michael McClain: So if you go all the way back to the training, we don’t have enough programs for CRNAs and anesthesia providers. So we don’t have enough supply at the education point. Then we don’t have enough providers. Then we don’t have enough. So I think it’s a, it’s a combination of things. I think it’s continuing to work with states.

Michael McClain: I’m a PA, so I’m a, you know, proudly licensed and, and, you know, still certified. Uh, don’t let me provide anesthesia. It’s, I’m a little bit out of practice, but, but PAs actually can provide anesthesia services in a number of states as well under a, under a, uh, Uh, an [00:13:00] anesthesia PA provider, there’s a, there’s a way to do that in certain states.

Michael McClain: But I think it’s continuing to look creatively at T models for providing anesthesia. It’s expanding the role of CRNAs. It’s expanding T models where it makes sense. But there is no shortcut. when you don’t have enough providers. And so it’s really making sure that you have the most appropriate, broadest set of capabilities in each state, having a reimbursement mechanism that allows for that.

Michael McClain: Uh, but here on the West coast, um, you know, we have hospitals and ASCs that are canceling elective surgeries because there simply aren’t enough providers. And so that all goes back to, there has to be enough educational programs that are supporting the development of those, but that takes time. That takes time.

Erik Sunset: And then I imagine the economic pressure that ASCs will now [00:14:00] face on maintaining either a relationship with anesthesia groups or being able to, you know, at a larger center, being able to Keep these anesthesiologists on staff. I mean, there’s not like a huge war chest, uh, full of stipends for anesthesia providers, uh, to be provided.

Erik Sunset: So what, what can a little old ASC do in this scenario?

Michael McClain: Yeah, I think that it goes back to the basic blocking and tackling of what made ASCs successful, maybe even 20 years ago. Um, you know, the most successful ASCs are those who are operationally sound, which means highly compressed. You’re not running three ORs when you can run two. Um, you’re focusing heavily on your payer contract so you can drive as much revenue as possible.

Michael McClain: Um, what the things that are attractive to anesthesia providers are highly compressed schedules are the fact for them to do as much that they benefit as much as surgeons do, uh, from [00:15:00] as many cases in a row in as few ORs as possible. So I think it’s, it’s really having blunt conversations with your surgeons and your anesthesia providers to say, How do we work together to get as efficient as possible?

Michael McClain: In that situation, anesthesia and ASCs are aligned. Uh, that they need to be as combined as possible. I also think having frank conversations with your anesthesia providers about stipends and the ability of an ASC to pay. Um, you know, gone are the days where every ASC is sitting on a 30 or 40 percent margin.

Michael McClain: Uh, typically ASCs aren’t running anywhere near those margins today. And so I think many anesthesia groups may have the impression that, Oh gosh, you’re, you’re running, you know, you’ve got cash coming out of your ears. That’s not necessarily the case, especially with a lot of, uh, the, you know, sort of the much of the equity that’s being purchased by management [00:16:00] companies, that’s going into management fees, third party, you know, administrators for all sorts of services, the margins may not be there.

Michael McClain: And so I think it’s having those frank discussions. And then third, not being afraid to shop your services. While that is not ideal, uh, you know, a much better relationship is to have a relationship with your anesthesia group. That is the same relationship you have in the hospital. Um, that’s ideal, but if that is financially feasible, you cannot risk putting the ASC out of business for a relationship.

Michael McClain: So if you need to shop services for smaller providers, you need to be creative and thinking about, should I employ my own CRNA and work on billing? You know, uh, the, just recognize that’s an entire change in payer contracting. Most ASC contracts are not set up to bill for or get reimbursed for anesthesia services.

Michael McClain: Most of their operating [00:17:00] agreements aren’t set up for CRNA services, so that requires a big reboot. So be careful as you step into that space because that’s going to take a lot of work, a lot of effort.

Erik Sunset: Well, that’s a call back to what you shared with us last time. And it’s a little bit of a, of a paraphrase here, but more is more and more scales, but different is different and it needs to be planned for.

Michael McClain: Yeah, yeah, absolutely.

Erik Sunset: Well, to turn our focus back to this final payment rule, and obviously we can meander from the surgery center to the provider to the anesthesiologist, wherever, wherever the road leads, but there were a couple of other sort of misses, uh, regard to this final payment rule as far as the ASC is concerned, and those revolve around new reporting metrics without a total understanding of the rule.

Erik Sunset: business model, which sounds like a crazy thing to say. We’re talking about Medicare issuing a rule, uh, for a site of service that they govern, uh, to an extent. So tell us a little bit about what could have been better there.

Michael McClain: Yeah, you [00:18:00] know, um, so what’s interesting is that, you know, Medicare has, has actually gotten some things right in the larger picture. Um, you know, Medicare did spend, uh, some time and resources to expand, uh, services around Indian health services, to expand some services around Medicaid, to allow some, uh, expansion outside clinic services, which is.

Michael McClain: Which is really great. It’s trying to truly, uh, take a look at social determinants of health. How can we, you know, collect more information on patients who maybe are more, uh, more poor, more vulnerable, and provide services in a more global fashion. They’ve also tried to streamline across multiple entities, clinics, hospitals, and now ASCs, the collecting of information that’s impactful.

Michael McClain: And, um, I don’t, I’m not sure if you know this, but earlier this year I, I worked with ASCA to, to help author an [00:19:00] article on the importance of ASCs, uh, in the role that we can play in assessing social determinants of health. You know, I’d run an ASC in downtown Seattle. We had a, we had both a large homeless and a large, uh, transgender and LGBTQ population.

Michael McClain: And we had gender affirming care through that facility. And it caused us to have to really sort of change our focus on how we interacted with a lot of our patient population. And I think that you have a ASC is we have the opportunity to play a big role In how we interact with, uh, what I guess I would say non traditional populations for ASCs.

Michael McClain: And so, We do have a role to play. Unfortunately, Medicare sort of took a broad brush and, you know, the first, uh, pass was to add OAS caps, which is the new outpatient, uh, mandated, uh, patient experience [00:20:00] survey process that goes into place in 2024 or in 2025. I’m sorry. That’s been. Threatened, if you know, for years, they’ve said it’s gonna happen, it’s gonna happen.

Michael McClain: Um, that does go into a place that’s mandated starting 2025. Uh, that is 39 survey questions. I don’t know about you, but I’m exhausted of answering 30. Patient experience questions everywhere I go, you know, I go to target, uh, you know, how was your experience in the restroom? Can you, you know, you go to Costco, they want to know, you know, was your experience hand washing good or bad?

Michael McClain: I think people, uh, people are just exhausted from that. And so now, uh, you’ll be required to answer 39 questions. It’s a little bit difficult to. Uh, it’s, you need a vendor. Most ASCs will require a vendor. And it’s going to take time, and it doesn’t really replace patient satisfaction. As a survey process, it’s something different, [00:21:00] so that’s a difficult to implement process on top of that.

Michael McClain: For 2025, they’ve now added, uh, some additional, uh, demonstration, uh, reporting. around social determinants of health. And while we, and I know even ASCA has come out with a similar statement saying, we fully support the idea of the roles ASCs can play in sort of assessing social determinants of health and sort of helping with the population.

Michael McClain: These questions are aimed at really hospitals and clinics, because the questions are asking patients about food insecurities, And about how they access, uh, healthcare. Uh, how is their financial security. Very personal, very intimate questions. And with the goal of identifying disparities, the problem is ASCs don’t have the resources [00:22:00] to respond.

Michael McClain: Whereas a hospital, a clinic, uh, you have social worker connections, you have programs to deal with this. So unfortunately, this broad edition of these reporting metrics are going to place ASCs in the position of asking difficult, uncomfortable questions of our patients. without being able to respond. And so, you know, do you have food insecurities?

Michael McClain: Do you have trouble paying your bills? Are you living in a socially threatening environment? Are you a victim of abuse? And when they say yes, well, that’s too bad. That must suck. That’s going to be a really difficult place to put our ASCs. And so, you know, what my fear is, is that we continue to add these complexities and failure to comply With these failure to supply the appropriate reporting results in, um, you know, a loss of that market basket [00:23:00] increase.

Michael McClain: I think it’s 3%. Don’t quote me on that. But I think, uh, that there’s a portion that you, if you don’t participate, you don’t get the full market basket increase. I think what Medicare is, is potentially going to run into is ASC saying this is way too much work. For, excuse me, for that small increase and they may actually end up getting ASCs who just say we’re done with this.

Michael McClain: And that defeats the purpose, the idea of the ASC Quality Collaborative and getting us involved. was for us to be able to show the outstanding care that ASCs provide. And we’re getting further and further away from that. Uh, I, I applaud Medicare with the idea of trying to get like for like, so that we aren’t comparing apples to oranges, but this is not the way to do it.

Erik Sunset: No, we we’ve already seen this movie before too, Michael, and not so much in the early days of [00:24:00] Meaningful Use, but as we evolved into macro MIPS after MU stage two, you had a lot of providers and a lot of organizations going. It’s not worth it. I’m, I’m not likely to achieve the bonus. Uh, so I might as well just eat the 3%.

Erik Sunset: Uh, move on with my day. I don’t have the staff. I don’t have the time. And I just don’t really care. These things don’t apply to the care I deliver to patients. So why bother?

Michael McClain: hundred percent, a hundred percent. That is exactly what we’re, we’re running the risk of. And I think because, you know, again, back to what ASCs really are, ASCs, in my opinion, are Medicare’s best tool to expand access and affordability for surgical services, bar none. I mean, the, the story, right. Is the same, and I talk about this in every conference I go to.

Michael McClain: Every, I was talking to a linen provider. You know, and this, this is the, this conversation point. You, [00:25:00] you talk to somebody about something simple. A total joint. Gets done at the hospital, and if we just use simple numbers, a patient has a 20 percent copay in the hospital, a 20 percent copay in the ASC. They have a 15, 000 bill in the hospital.

Michael McClain: They have a 7, 500 bill in the ASC. 20 percent of 15, percent of 7, 000. Which do you want to pay? That’s the the math that we’re talking about. You’re more, and if the outcomes are the same, Or even, as we would say, probably better, wink wink, in the ASC. Why would you not want to encourage every patient clinically appropriate to go to the ASC?

Michael McClain: for as many procedures as possible. It’s better for Medicare, they pay less. It’s better for the patient, because it’s closer to where they work and live and it’s a lower out of pocket cost. And if the [00:26:00] hospital could then use that change to get more appropriate funding for the higher acuity cases that they could and should be doing, this should be a win win.

Michael McClain: The problem is the savings that the hospitals are getting are not being turned back to their high acuity cases, it’s being pocketed. So it’s not incentivizing the movement for them either. So the system is not incentivizing the movement of cases to the ASC. And that, that’s the bigger bureaucratic infrastructure problems that need to get solved.

Erik Sunset: And I just, my mind goes to, uh, you know, we’re talking about procedures that are planned, elective procedures, not an emergency room visit when we’re talking about the ASC. The adherence to care has got to be significantly better when my procedures at the ASC, my significant other is going to drive me in first thing in the morning and I need to go home.

Erik Sunset: I don’t have to dread a visit into the [00:27:00] hospital to check in and I’m with all these critically sick patients or walking through God knows what to get to the wing of the hospital that I need to be in. It just, my mind doesn’t compute the lack of alignment in this value chain. Something, something’s wrong.

Michael McClain: It it, it, it is, it is so much more, uh, comforting. accessible, predictable. Um, you know, every factor lines up from an ASC perspective for, for patients, for surgeons. Um, it, it is a much more predictable, safe and controllable environment. Now that being said. Um, you know, uh, I’m working right now, uh, on a white paper with some colleagues of mine at Lightbulb Cardiac.

Michael McClain: We’re talking about EP, uh, uh, you know, in terms of, uh, procedures around the, the cardiac space that’s, that [00:28:00] we’ll be putting something out here in the next few weeks. Um, but really around the safety of cardiovascular procedures, you know. As new technology moves into the ASC space, some of these new procedures, especially you get into electrophysiology, you get into cardiac, that’s not the same as total joints.

Michael McClain: That’s a whole new animal. There’s still a big role for ASCs to play, but it’s going to be training intensive, education intensive. But again, that role should be there and it’s not. Um, and it, and it’s just simply. It’s frustrating that Medicare has yet to see the value.

Erik Sunset: Well, and I just want to add one thing to that. You, you know it better than I do, but from the, the experts in the cardio space that I’ve gotten to talk to, you know, the surgeons are comfortable. They know what’s appropriate for their patients. And it’s, you know, it’s not quite a unilateral decision, but it’s pretty close.

Erik Sunset: You know, you’re, you’re begging me [00:29:00] to do this procedure in the ASC, but you were not going to do it there for whatever reason, surgeons call, that’s fine. The surgeons are not rushing procedures to the ASC. They want to do them there. The cardio surgeons, that is. They want to do those procedures in the ASC when it’s right, there should be no blockers in that instance.

Erik Sunset: You know, easy for me to say sitting here, uh, you know, on the vendor side as opposed to the legislative or even the care side.

Michael McClain: Yeah, I, I will, I’ll add as a, as a clinician, I’ll add one like little wrinkle, but you know, the talk that I just did at Waska, the one piece that I add is that that, uh, I agree that surgeons should absolutely be in charge of that as long as nurses and anesthesiologists are in the conversation as well.

Michael McClain: Because I think that the, what happens skin to skin in the, in the surgeon’s purview is different than what happens on the front and the back end. Uh, you have to have all of those pieces aligned. [00:30:00] Uh, and sometimes work that it takes up front and the work that it takes on the back end, um, can make all the difference.

Michael McClain: And I think that’s, that was certainly true with total joints in the first few years is that. the ease of the surgery compared to the pre op and post op piece. It took a little while to sort of get those pieces aligned. CV serves services are going to be the same thing. It’s going to take a little while to really get it tuned in.

Michael McClain: Uh, but absolutely that decision should be made with the clinicians, not, uh, sort of an abstract decision by a government or a certificate of need decision or, uh, a federal payer, whatever.

Erik Sunset: Yeah, perfectly said. So as we, uh, look to close out our, our show here, Michael. What would be a word to the wise for ASCs as they’ve gotten this, uh, this payment rule into their inboxes and they’re reading it online and starting to make plans for [00:31:00] 2025.

Michael McClain: Um, well, like anything, um, your reimbursement is the most important part of your business. You need to know what you’re getting paid and don’t assume you’re being paid correctly. So monitor your claims like a hawk. Know what’s going up and going down, you know, when we say there’s a 2. 9 percent increase That doesn’t mean across the board.

Michael McClain: There are things and you know, even my team’s just starting to look at what that means specifically Some rates will go up some will go down Make sure you download the full Medicare rule make sure if you’re using a rev cycle company, they have it So you know exactly what you’re supposed to get paid in it and you’re getting paid exactly what you should be paid.

Michael McClain: Cause it’s not surprising. Um, you may not get paid correctly until March because things will go up and down. So make sure that you’re getting paid correctly. That’s number one. Number two, [00:32:00] uh, watch your commercial payers. Because many commercial payers base their payment systems on Medicare and you may see commercial payments change as well.

Michael McClain: So again, watch all your commercial payments. And then number three, if there are things, uh, that you feel should be on the next round, you know, Medicare will begin taking, uh, Testimony, uh, fairly early next year, and they’ll produce their 2025 proposed rule. Um, you know, I’m already hearing a lot of conversation from cardiovascular organizations.

Michael McClain: You’re, you always hear, I don’t want to say noise, but you always hear a lot of discussion from orthopedic and spine groups. I think there’s going to be a lot of clamoring for expansion of services across multiple areas. Um, but most importantly, Get involved. [00:33:00] I think one of the areas from an ASC standpoint where we have opportunities is in general political advocacy.

Michael McClain: And maybe it’s not as an administrator. Most of us, I remember my time as an administrator, I didn’t have money to donate to political campaigns. I mean, we all work for a living. Um, but, you know, reach out to ASCA, reach out to your state organization, find out if there’s ways that you can participate. Can they, you know, I sit on the ASCA pack board.

Michael McClain: So I’m trying to work with organizations to help get some funding, to bring ASCA administrators to Washington, DC, uh, to help them figure out how to. Help their physicians raise money, because the only way that we make some changes here is to have politicians hear our story, and the only way you do that is in person. And so, uh, try to [00:34:00] find ways to get involved. It’s, um, because the more we are vocal. And whether it’s meeting with your local congressman or representative or senator, or you’re traveling to Washington and stumping the hill with ASCA or your state board, that’s the only way things change. Because otherwise we just stomp around and we’re angry and we get what we get.

Michael McClain: So take the opportunity to get involved.

Erik Sunset: And I’ll add to that, if you’ve listened to this episode and you are not a member of ASCA, now is the time to become one. Uh, the next ASCA, uh, annual conferences in Denver, late April, early May, we’ll see you there, certainly. And then to go even a step farther, your state will have an ASC association. It’s a different acronym depending on which state you’re in.

Erik Sunset: Find that and join that and get active there. Um, like I said, Michael, you don’t need to be writing big checks, uh, off to wherever they need to go to make something move, but your membership in these organizations helps drive the funding to advance the cause of [00:35:00] ASCs.

Michael McClain: And your participation, uh, even if it’s on a webinar, or even if it’s, uh, serving on a committee, your expertise, your hour once a month matters.

Erik Sunset: And with that, Michael, where can listeners connect with you?

Michael McClain: So, you can certainly catch us on LinkedIn, follow me, or, uh, Left Coast Adv or Left Coast Healthcare Advisors, or you can stop at our website, which is www. lcha. org. visors. So lchadvisors. com.

Erik Sunset: It’s that easy. And I’ll of course have links to, uh, all of these places in the show notes. Michael, thanks again for joining us and helping us break down the, uh, the 2025 final payment rule.

Michael McClain: Anytime I love dropping into chat with you, Erik, it’s always a blast.

Erik Sunset: Uh, thanks again. And on behalf of the entire DocBuddy team, we appreciate you listening. Be sure you’re [00:36:00] subscribed on Apple podcasts, Spotify, and YouTube, so you always get the newest episodes of the show and until next time, we’ll talk to you soon.

Michael McClain: Thanks.