Running a fixed-price ASC is less a billing innovation than an operational discipline, according to Tom Valentine, the new president of Zionsville, Ind.-based WellBridge Surgical.
Mr. Valentine, who joined the free-market ASC May 1 after roughly two months of preparatory work with the ownership group, came not from healthcare but from manufacturing. Previously serving as the executive vice president of sales and marketing at Remee Wire and Cable, Mr. Valentine was hired because WellBridge was looking for an operator, not a clinician.
The all-inclusive bundle pricing model WellBridge has built is more operationally complex than it appears. In a traditional fee-for-service environment, inefficiencies get absorbed into the reimbursement structure. At WellBridge, they cannot.
“If you miss a cost, you can’t send a supplemental bill,” Mr. Valentine said. “Your cost projections have to be right.”
That means tracking implants, staffing, anesthesia, surgeon fees, supply utilization and room-to-room turnover times with precision most ASCs have not historically needed. Mr. Valentine frames the challenge in manufacturing terms: scalability, profitability, retention and repeatability.
WellBridge is the first facility in the country to agree to all-inclusive bundle pricing across a complete list of outpatient CPT codes, with charge masters that both Anthem and United Healthcare have signed off on.
Education remains a second pressure point. Employers and patients are receptive to price transparency in principle, Mr. Valentine said.
“There’s still a perception that lower cost means lower quality — that you’re getting surgery out of the back of a bus,” he said. “In reality, ASCs routinely deliver equal or better outcomes with a far more efficient care model.”
Physician recruitment is a third pressure point, particularly in orthopedics, where hospital systems have spent years acquiring surgeons and restricting case leakage through employment contracts. Mr. Valentine said the most receptive recruits tend to be surgeons in their 50s who retain business instincts and have grown skeptical of the hospital employment model.
“The doctors who are most receptive are the ones in that 50-to-60 range — still have business savvy, have seen enough of the transition, and are starting to ask whether the hospital model is really serving them,” he said.
The broader goal, Mr. Valentine said, is to prove the model can be replicated to the point that it can expand into other markets. WellBridge is intended as proof of concept for self-insured employers seeking a credible alternative to hospital-based surgical care.
“There are a lot of self-insured businesses out there trying to find their way through the idea that they can significantly cut employee healthcare costs,” he said. “WellBridge is an answer to that problem, and I intend to prove the model works — and then take it elsewhere.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.