As cost pressures intensify, ASCs are increasingly positioning themselves as cost-effective alternatives to hospital settings — especially for high-cost procedures like joint replacements and spine surgery.
For Benjamin Stein, MD, an independent orthopedic surgeon and co-founder of Germantown, Md.-based Capital Surgical Solutions, a new opportunity is arising in direct-to-employer contracting.
“We are seeking novel partnerships with self-insured employers to dial in our ASCs’ unique ability to deliver best-in-class care but at low cost in the realm of high-cost orthopedic procedures such as joint replacement and spine surgery,” Dr. Stein told Becker’s.
Direct contracting with employers has long been touted as a promising strategy for ASCs and physician groups. By cutting out middlemen like commercial insurers and third-party administrators, providers can offer competitive bundled pricing and improved outcomes directly to the employers.
However, despite the theoretical appeal, implementation has proven challenging.
“I think the biggest hurdle is just connecting the dots,” he said. “It’s really about getting to the key decision-makers at these small, medium and large-sized companies that are self-insured but use third-party large company management, commercial payers or TPAs.”
Once those connections are made, Dr. Stein said, the next step is translating clinical and financial data into compelling, digestible insights for employers. To do that, Capital Surgical Centers has built a proprietary analytics platform aimed at giving employers a clear, unvarnished look at the value proposition ASCs can offer.
“It’s the core of our strategy,” he said. “Once I’m connected to an employer, having transparency in the data — what we cost and how we can deliver care to their employees with hip or knee arthritis, in a high-value, best-standard-of-practice way — is key. And the only way to achieve that is through transparency.”
With growing national focus on healthcare price transparency, Dr. Stein believes that clean, reliable data isn’t just a bonus, it’s essential.
“If the price transparency is based on murky data, or data that’s not reliable, or isn’t going to be consistently deployed in a way that benefits the people insuring their employees — or the facilities, who need to know they can be viable on those numbers — then it doesn’t work,” he said.
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