Pairing a low average cost per case alongside strong outcomes can give independent ASCs a leg up when negotiating contracts with payers.
For ASCs that are affiliated with a health system, same-day surgery conversions and site-of-service migration rates can create a shared incentive between payers and hospitals to move services into the ASC setting.
Melissa Rice, administrator of Loyola Ambulatory Surgery Center, Trinity Health in Oakbrook Terrace, Ill., recently connected with Becker’s to talk about how centers can best back up their case with metrics and numbers.
Note: This response was lightly edited for clarity and length.
Question: Which specific performance metric has had the biggest impact on your payer contract negotiations, and how did you use it to support your case?
Melissa Rice: From an independent ASC perspective, the performance metric that has had the most impact in payer negotiations is consistently low total cost per case — especially when paired with strong outcomes data. Independent centers are often able to demonstrate a significantly lower all-in episode cost compared to hospital outpatient departments, particularly for high-volume procedures like orthopedics, gastroenterology and pain management. In negotiations, we’ve leaned heavily on aggregated claims comparisons and internal case costing to show 30% to 50% savings while maintaining equivalent or better complication and readmission rates. Presenting this alongside payer-specific leakage data — highlighting where cases could be safely shifted to the ASC setting — has made the value proposition tangible and financially compelling.
Equally important for independent ASCs has been patient satisfaction (CAHPS or equivalent surveys), particularly as payers increasingly tie network design to member experience. We’ve used consistently high satisfaction scores, combined with on-time starts and low cancellation rates, to differentiate ourselves as both a cost-efficient and patient-centered option. In contract discussions, these metrics help move the conversation beyond fee schedules to value-based alignment, including opportunities for narrow networks or preferred provider status.
From the perspective of an ASC within a healthcare system, the most impactful metric has been same-day surgery conversion and site-of-service migration rates. Health system-affiliated ASCs are uniquely positioned to show how shifting appropriate cases out of higher-cost hospital outpatient departments reduces overall spend without fragmenting care. We’ve used internal system data to quantify how moving targeted procedures into the ASC improved throughput in the hospital while lowering payer costs — creating a shared incentive. This system-level lens resonates strongly with payers looking for scalable cost containment strategies.
Additionally, system-based ASCs have leveraged quality metrics such as low infection rates and minimal unplanned admissions, supported by enterprise-level data analytics and benchmarking. When paired with care coordination capabilities and EHR integration, these metrics help demonstrate reduced post-acute utilization and better longitudinal outcomes. In payer negotiations, this allows us to advocate not only for competitive reimbursement but also for inclusion in bundled payment programs or value-based arrangements where the ASC plays a central role in driving both quality and cost efficiency.
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.