3 big reimbursement and payer trends for ASCs + what happens when patients rate shop

CEO of Peabody, Mass.-based Orthopedic Surgical Center of the North Shore Jarett Landman, MS, PA-C, discusses the key reimbursement and payer trends for ASCs today.

Question: What changes have you seen in payer coverage at your ASC over the past few years? Are you anticipating any other changes for 2019?

Jarett Landman: As a positive, I have found that payers have been more willing to partner with ASCs for creative payment methodology. Commercial bundles and implant/CPT carve-outs have enabled us to increase the breadth of cases we can perform. The financial viability of cases is no longer an issue for outpatient, in-network centers.

Q: How is your center dealing with the trend of higher deductibles and increased patient responsibility?

JL: Education, like all things, is paramount. We take ample time to review patient responsibility before arriving at the center and try our best to be transparent with costs. We remind patients, in an empathetic way, that the deductible is the patient's covenant with their insurer as a term of their coverage, not an inflated charge from the center. We also recommend medical consumerism, particularly asking patients to 'rate shop' local hospitals. Almost all of the patients return to us after seeing the impact on their deductible for the same procedure in the hospital setting!

Q: As payers consolidate, and acquire healthcare providers, where do you see ASCs having the biggest opportunity to succeed?

JL: ASCs will always provide a high-quality, low-cost alternative to hospitals and HOPDs. As payers consolidate, there is only going to be increasing downward pressure on reimbursement. Having learned how to be efficient and nimble in the ever-changing healthcare market will serve ASCs well in negotiating and adapting to these evolving payer relationships.

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