As anesthesia stipends climb, some ASC leaders are taking the bill to the payer negotiating table. Their argument is that payers who benefit from moving cases to a cheaper site of service should also pay for the anesthesia coverage that keeps that site open.
“When a case moves to an ASC, we’re saving the payer a real site-of-service cost,” said Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y. “If they want that savings, and don’t want us using out of network providers, they need to pay a fair in-network anesthesia rate. They can’t have it both ways.”
Mr. Bachani said anesthesia groups once covered their own costs and sometimes generated revenue through out-of-network billing.
“While IDR isn’t gone, it’s become tougher to rely on as payers go after ASCs that allow out of network providers,” he said.
ASCs offer a lower-cost site of care, and those savings will matter more as payers and policymakers move toward site-neutral payment. Commercially insured patients paid 32% more for screening colonoscopies in hospital outpatient departments than in ASCs in 2022, and 58% more for diagnostic colonoscopies, according to a Blue Health Intelligence analysis of Blue Cross Blue Shield claims. HOPD costs ran 56% higher for cataract surgery.
Jamison Pearlman, vice president of managed care at Fresenius Medical Care North America in Brentwood, Tenn., said operators need to put numbers behind the argument.
“ASCs should demonstrate the savings generated by moving appropriate procedures out of hospital outpatient departments and quantify the anesthesia expense required to preserve that lower-cost access point,” Mr. Pearlman said. “Payers cannot continue to promote outpatient migration without recognizing the infrastructure and workforce costs necessary to sustain it.”
Some centers are getting further by negotiating alongside their anesthesia group. Santa Cruz (Calif.) Surgery Center secured a bundled payment arrangement with a managed Medi-Cal plan, according to CEO and Administrator Lisa Cooper.
When a bundle isn’t available, she said, the ASC and anesthesia group can go to the payer together and explain that without competitive anesthesia reimbursement, “the surgery center ultimately cannot afford to continue supporting that payer’s members.”
“We have found that approaching the payer as a team — the ASC and anesthesia group together — is much more effective than either side trying to address the issue independently,” Ms. Cooper said.
Dan Decker, co-founder and urologist at Vitality Plus Urology Clinic in Mountain Home, Ark., said bundling “the entire patient experience at ASCs” is the idea with “the most potential for an actionable and timely solution.”
He said hospitals already benefit from that kind of model, while ASC payment stays split into separate buckets even though a cohesive team approach is one of the ASC model’s strengths.
Mr. Pearlman said no single party can close the gap on its own.
“Ultimately, the solution is not simply asking anesthesia providers or ASCs to absorb more pressure,” he said. “It requires better alignment among facilities, anesthesia professionals, physicians, and payers.”
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.
