Healthcare consultant Gregg Gordon, who launched Surgical Solutions IPA in 2024, recently joined Becker’s to discuss how payers have “historically undervalued the ASC model,” and what it will take to shift that dynamic.
Mr. Gordon, who has worked on both the provider and payer sides, said payers often focus narrowly on unit cost and reimbursement rates, overlooking the broader value ASCs deliver.
“Things can get really myopic on the payer side,” he said. “What’s often overlooked is everything else ASCs bring to the table beyond just the price.”
Surgical Solutions IPA was formed to unite independent ASCs and improve their leverage in payer negotiations, aiming to cut administrative burdens and reduce total cost of care.
“It’s not just about fee-for-service payment,” he said. “It’s about data collection. It’s about the patient experience at an ASC versus a hospital. It’s about post-procedure care, lower recidivism and avoiding complications.”
Despite offering lower-cost care, ASCs still face resistance in proving their value. But ASCs are often safer, more efficient and more physician-friendly than hospitals, Mr. Gordon said.
“All the data shows ASCs are safer, better and preferred by patients,” he said. “Even physicians have better experiences. At hospitals, they’re competing for OR space, but ASC leaders treat them as partners. They roll out the red carpet — asking what times they want, which rooms they prefer. It’s a very different approach.”
The core challenge, he said, is getting payers to look beyond line-item costs to total cost and performance.
“From a total cost perspective, health systems account for 60% to 65% of what payers spend,” he said. “If payers could chip away at that by shifting volume to higher-performing, lower-cost ASCs — and the metrics back it up — why wouldn’t they explore that?”
Other ASC leaders share this frustration. Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites of Waltham, Mass., and president of Massachusetts’ ASC association, told Becker’s his team often has “no leverage” in payer negotiations due to the lack of out-of-network threats and limited transparency around payer cost savings.
“It’s very tough in our state, where most of our contracts are statewide, with very little negotiation,” he said.
Mr. Gordon believes payers already know ASCs offer cost advantages in specialties like GI, ophthalmology, orthopedics and cardiovascular care. He proposes a data-driven trial: pay ASCs slightly more over six to 10 months, then review the impact.
“Did total cost go down? Did [key performance indicators] improve?” he asked. “ASCs will share that data — hospitals don’t. That data helps payers with risk scoring and premium optimization. It’s a win for them, too.”
Payers are beginning to take notice. A Blue Health Intelligence analysis found procedures can cost up to 58% more in hospital outpatient departments versus ASCs or physician offices. Colonoscopies, for example, cost 32% more in hospitals.
UnitedHealthcare’s 2023 site-of-service policy is one example of a payer initiative nudging more procedures toward ASCs.
“This model helps them get there,” he said. “We’re the advocate — helping them meet the very goals they’ve already laid out publicly.”
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