As payers continue pushing care into lower-cost settings, ASCs are being held as a solution.
But leaders at Deerfield, Ill.-based SCA Health say some reimbursement policies, particularly those around anesthesia, risk undermining the site-of-care strategy insurers are trying to advance.
Lindsay Lowder, group vice president of operational innovation and strategy at SCA Health, told Becker’s that one of the biggest disconnects she sees concerns anesthesia reimbursement.
“Payer reductions to anesthesia reimbursement often get passed back to facilities through stipends or guarantees,” she said. “That’s an unintended consequence and can threaten the ASC business model, even though ASCs are a lower-cost site of care overall.”
While anesthesia contracts are typically negotiated separately from facility agreements, their financial impact isn’t siloed. When anesthesia reimbursement declines, anesthesia groups often seek financial support from ASCs in the form of things like stipends to maintain coverage.
Complicating matters, the anesthesia and ASC negotiations frequently happen with different teams at health plans, Ms. Lowder said. As a result, facility contract negotiators may not immediately see how anesthesia policy changes ripple through an ASC’s financial model.
“It often comes as a surprise to them that these reductions impact sustainability,” she said.
Matthew Humbarger, SCA Health’s group vice president of payer engagement and strategy, said there is no simple fix.
“We haven’t found a silver bullet,” he told Becker’s. “A lot of it is education — helping payers understand the downstream impacts of anesthesia reimbursement policies.”
Beyond anesthesia, SCA Health leaders say another misconception is treating ASCs as interchangeable commodities. Standardized reimbursement structures, Mr. Humbarger said, often fail to account for variation in service lines, case complexity and patient experience.
“ASCs are highly differentiated and deliver high-value care, and reimbursement policies should reflect that,” he said. “Not all ASCs are the same, and policies should reflect differences in services, complexity and patient experience.”
When payers recognize those distinctions, particularly through value-based arrangements that align incentives around quality and total cost of care, the results can be mutually beneficial, he said.
