ASCs have seen a wide range of changes to payer policies in the last year, from narrower reimbursement models to a shift toward bundled payments and alternative payment models.
Here are five ways that ASCs are adapting to the shifting payer landscape:
1. Meeting the moment with increased transparency. John Brady, CEO of Fox Valley Orthopedics in Allonquin, Ill., told Becker’s that his practice has seen a heightened interest in the director-to-employer and consumer marketplace over the last year, along with more patients utilizing digital marketplaces and bundled pricing. To meet this growing industry trend, his ASC is focusing on setting “appropriate” pricing and ensuring that there are no surprises post-billing for patients.
“The early returns are positive, so we’re optimistic that with increases in those choosing high-deductible plans and employers looking to optimize their healthcare spending, we’ll be able to meet their needs in the ‘direct to’ market,” he said. “In addition, we are also applying greater attention to data management and analytics in our conversations with payers. The ambulatory level is considerably less expensive than the inpatient or [hospital outpatient department] levels of care, and the outcomes are at least equal to those settings, if not better. Through the incorporation of patient-reported outcome measures we intend to be more proactive in making our case to support our efforts when negotiating payer contracts.”
2. Sharp monitoring of product and supply costs. Honing in on supply costs at the clinical level is one way that ASCs are stabilizing finances as payer policies shift and change.
“From the ASC side, we are monitoring rising costs of products and maximizing contribution margin by having discussions with physicians to ensure clinical-appropriate products are used in the most cost-efficient way,” Jennilee Caffey, regional administrator at Baylor Scott & White Sports Surgery Center at The Star in Frisco, Texas, told Becker’s. “As we continue to look ahead, we are working with vendors to create local agreements for rebates, high contract compliance and high/low structures.”
3. Doubling down on strong communication. “The biggest emphasis in our payer strategy has been to continue to build strong relationships with ongoing communication and transparency with payers,” Janet Carlson, vice president of Ambulatory Surgery Centers at Commonwealth Pain and Spine in Louisville, Ky., told Becker’s. “Our ASC platform offers a significant cost savings opportunity for payers and patients; we welcome the opportunity to share quality outcomes and patient satisfaction scores to demonstrate our partnership in reducing the traditionally high cost of surgical care. We are also mindful of the need to establish and maintain a clear plan for negotiating ASC rates, considering both on-cycle and off-cycle negotiations with payers. With the increasing shift of surgical care migrating to the ASC space, we have a roadmap for communicating our value proposition to ensure we are being reimbursed fairly for the excellent, reproducible care provided to our patients.”
4. Exploring alternative payment models. As ASCs continue to face declining reimbursement and financial uncertainty, many have begun seeking out alternative methods for payment and billing.
“Many surgical centers and anesthesia practices are exploring direct-pay bundles and concierge anesthesia services that bypass third-party payers altogether,” Jack Dillon, CEO of Grand Rapids, Mich.-based Anesthesia Practice Consultants told Becker’s. “These models offer transparent pricing, faster payments and fewer administrative burdens, ultimately allowing clinicians to focus more on quality and patient experience. By aligning with employers, direct-to-patient payment platforms, and value-based care initiatives, we’re not just adapting — we’re building a more sustainable and patient-centered future outside the constraints of traditional insurance.”
5. Elevating and leveraging data analytics. Given that ASCs are often a lower-cost option for many surgical procedures, strong data is one of an ASC’s most valuable tools in contract negotiations with payers.
“This past year, we focused on collecting, analyzing and leveraging payer reimbursement data to strengthen our negotiating position and prepare for future reimbursement challenges,” Tara Good-Young, CEO of Windsor, Calif.-based Pediatric Dental Initiative of the North Coast told Becker’s. “Using verified data, we petitioned for improved rates while educating payers, as well as state and county representatives, on the critical role our center plays across 16 surrounding counties.”
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