Q: What impact is the economy having on ASCs?
Marc Koch: In front of the backdrop of declining volume and payor mix shift to less favorable case reimbursement, ASCs are looking to anesthesia departments to share the pain. Anesthesia service providers fall into two broad categories: those with anesthesia departments that are cash flow positive and those that are cash flow negative. In the former instance, ASCs sometimes try to convert the ASP revenue stream to an ASC revenue stream. Nearly always and despite assurances from lawyers or crafty anesthesia organizations, these arrangements run afoul of state or federal laws and place the ASC and the owners at criminal or civil risk. Getting out from the underbelly of ASC anesthesia relations, some of the more wholesome ASCs will ask their anesthesia group to find ways to consolidate rooms, improve turnover, reduce supply expense or otherwise improve revenue or reduce expenses.
Q: What is the most important thing an ASC can do in 2009 to preserve profits?
MK: It is likely that most patients who have lost their jobs will find some way to preserve health insurance through COBRA. That being said, many plans have co-payments and deductibles in place to help curtail overutilization of medical services. In other words, when medical care costs a patient something, it makes them think twice before accessing services. However, it may serve a more sinister end — it may actually prevent patients from accessing necessary care. Surgery centers and patients are permitted to write-off co-payments or deductibles, but they should clearly document economic hardship and, in addition, not make this a matter of routine on each and every patient but only for patients who are facing genuine economic hardship. In addition, understanding that a patient’s life may have been turned topsy-turvy, kindness, empathy, understanding and concern go along way. For instance, a patient may have forgotten to be NPO and enjoyed a breakfast the morning of surgery. Understanding that recent unemployment, failed mortgage payments and depleted 401K may have gained more mindshare than your preoperative instructions will go along way to developing patient loyalty.
If you would like to share your thoughts regarding these issues, please send them to Scott Becker at sbecker@mcguirewoods.com.
