3 key points on ASCs, payer consolidation and high-deductible health plans

Under the ACA, payer consolidation is on the rise — as evidenced by the Aetna-Humana merger earlier this year — as are high-deductible health plans. A group of ASC leaders and experts discussed how these trends affect surgery centers during a panel at Becker's ASC Review ASC 23rd Annual Meeting: The Business and Operations of ASCs on Oct. 28 in Chicago.

The panel featured Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites in Waltham, Mass.; Alfonso del Granado, administrator of Ashton Center for Day Surgery in Hoffman Estates, Ill.; Sarah Malaniak, administrator of Ambulatory Center for Endoscopy in North Bergen, N.J.; and Matt Kilton, associate principal of ECG Management Consultants. Scott Becker, JD, publisher of Becker's Healthcare, moderated the panel.

Below are three key points on how ASCs can successfully navigate the rise of high-deductible health plans and payer consolidation, pulled from the panel discussion.

Put in a self-pay kiosk. High-deductible health plans require patients to take more financial responsibility for their care, meaning ASCs need to be more proactive about collecting from patients. Ms. Malaniak said a large portion of her center's patients have high-deductible plans.

One simple addition at Ambulatory Center for Endoscopy has drastically improved payment rates: a registration kiosk. The kiosk prompts patients to pay there, and patient payments have improved from $500 per month to $7,000, Ms. Malaniak said.

In fact, the kiosk "paid for itself 10 times over" in just one year.

Educate, communicate and negotiate with payers. With margins getting slimmer, "you cannot sign the contract they put in front of you," Mr. del Granado said. To get a favorable contract, ASC leaders need to stay in contact with payers and work with them.

For example, at Boston Out-Patient Surgical Suites, physicians from the ASC spoke on the phone with insurance companies' medical directors, and the center even offered cite visits to medical directors. "Physicians talking to them was key, I think," said Mr. DeConciliis.

Don't sign poorly paying contracts. Sometimes it can be tempting for an ASC to sign a contract with bad rates to appease a payer or boost patient volumes, but multiple panelists counseled against this tactic. "If you're performing services with losses, I would implore you to stop," said Mr. Kilton. "Try to limit or cease non-pay services."

Mr. DeConciliis had a similar message. "If you're getting paid poorly, stop."

It's important to not take a loss on a contract because it communicates to other payers that a center can do a service at that lower rate, and if one payer is getting a low rate, others will negotiate down as well. Even if a payer represents a small portion of a center's business at one point, that payer could get acquired, and then the new large health plan will want the lower rate, Mr. Kilton said.

Though the current payer landscape can present some challenges to ASCs, keeping in mind these three tips can help surgery centers stay in the black.

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