ASC Payor Trends & the Formation of the Surgery Center Network: Q&A With Jeff Blankinship of Surgical NotesPresident of Surgical Notes Jeff Blankinship discusses payor trends for surgery centers and the launch of Surgery Center Network, a new service that highlights and connects ASCs to the general public, insurance plans and group health and workers' compensation employers.
Q: Why did Surgical Notes develop the Surgery Center Network? How does it address some of the issues facing providers, patients and insurance companies today?
Jeff Blankinship: Surgery Center Network was created to accomplish a few key initiatives: first, to be an advocate and cheerleader for the quality of services that ASCs provide, something that many consumers/patients and even health plan representatives don't realize. Second, SCN was developed to specifically and directly channel patients into ASCs from group health and workers' compensation payors, including third party administrators (TPAs), self-funded employers and other stakeholders. Third, SCN was developed to help these employers and administrators gain access to high-quality, lower-cost ASC facilities that accept cash pricing and don't need to worry about the costly efforts to chase patient liability. The costs at an ASC are so much lower than at a hospital that even with benefit incentives such as waived co-insurance, the overall costs to the plan remain far lower at the ASC than at the hospital.
Q: What are the biggest trends you are seeing develop in the relationship between ASCs and insurance companies?
JB: First, we need to clarify that when discussing SCN's health plan partners, we are talking mostly about self-funded group health plans and not traditional health insurance …yet. About 60 percent of U.S. companies are self-funded under the ERISA laws, and more are moving towards self-funding because of the Affordable Care Act. Self-funding allows employers and their administrators to "write their own rules" since it's the employer's money that's paying the claims, thus they can be very creative in exploring new ways to manage claims costs. This includes narrow or specialty carve-out networks to drive patients into centers of excellence providers at lower cost points. ASCs are a natural fit for self-funded employers and their administrators to partner with in these kinds of creative claim cost management issues. As for traditional insurance from Blue Cross, UnitedHealthcare and others, they are not interested in these kinds of programs because they fly in the face of their hospital system partners.
Q: How can surgery centers benefit from increased transparency and participation in the network?
JB: The dramatic movement underway across the country is for price transparency in healthcare. This includes concepts such as "Medicare-plus" pricing or "cost-plus" pricing or direct-contract providers. Concierge healthcare, nurse navigators and health guides are all terms used to describe the process of moving patients through the continuum of care to the best providers at the best pricing. Healthcare is the solitary purchase that consumers make where they have no idea what the cost is until after they have "purchased" the service. Employers and administrators are fed up with the arbitrary, random and wildly variable pricing from one hospital to the next for the same procedures, and also with the arbitrary "discounts" from the PPO networks that yield arbitrary and irrelevant "savings."
Instead, the healthcare purchasers want to know what the cash price is today — just like you want to know what the cash price is today when you go to the grocery store. By participating in price transparency initiatives, ASCs will present themselves as excellent and desirable alternatives to hospitals; will receive more cases; build patient, employer and surgeon loyalty; and will see better cash flow.
Q: What advantages will the network provide for ASCs treating workers' compensation patients?
JB: For workers' compensation, the advantages will vary from state to state, depending on the rules that each state's workers' comp commission has in place for reimbursement for work-injury cases. Some states are far more appropriate for the SCN's model than other states. That being said, most workers' comp administrators and employers want excellent prices at quality providers, so ASCs that participate in SCN and receive workers' comp patients will have far less paperwork and consistent and simple claims pricing — and they will be paid far more timely, too.
Q: Where do you see the network heading in the future?
JB: We see SCN becoming the national choice for transparent pricing on behalf of the self-funding group health and workers' comp segments of healthcare. In fact, we already have commitments from TPAs and employer groups encompassing well over 3 million total lives. We anticipate that when fully involved, SCN will be facilitating hundreds of procedures each day across the county, including most of the common outpatient procedures, as well as ancillary services such as radiology and physical therapy. While SCN is still in its infancy, we have already partnered with many leading organizations throughout the healthcare industry that will undoubtedly help us achieve these objectives.
Learn more about the Surgery Center Network.
More Articles on Surgery Centers:
ASC Valuation Analysis: 3 Biggest Opportunities for Improvement
15 Statistics on Orthopedics in ASCs
6 Recent Surgery Center Acquisitions
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