Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites and president of Massachusetts Association of Ambulatory Surgery Centers, joined Becker’s to discuss his team’s data-first, payer-education approach to rate defense.
Editor’s note: This interview was edited
Question: How are you approaching contracting and other types of rate defense?
Greg DeConciliis: This is geographically or state dependent. We’re in an area where we have a lot of statewide contracts, not necessarily negotiating with us as individual centers. We’re trying to work with payers to recognize that we’re safe. We meet with them individually and say, ‘You’re saving money by having a case done in our surgery center. By lowering rates, you’re not covering the costs for us doing this — you’re reducing or eliminating our margin. We need to share in the margin you’re making by doing the case.’
We need to educate them. I’ve always found the best way to approach payers is to show them what goes into a surgery and what it actually costs. We’re not just picking numbers out of a hat. Also you fall back on: ‘What are you paying the hospital? Pay me X amount of what you pay the hospital and you’ll save money and that amount will be good for me.’ But sometimes they just get the lowest rate they can out of the ASC, realizing the alternative is the hospital — a higher-cost setting. We don’t always feel like we have negotiating strength, and we should feel stronger there.
The best way we can approach contracting is by having an expert do it, especially for a mom-and-pop ASC that doesn’t have a management company. One benefit of a management company is power and resources to negotiate or use a contracting agent. This is an area where centers can get a big bang for their buck. People get scared by the cost, but the returns can be exponential.
So for us, we’re analyzing our contracts and cases. We’re still looking at certain cases we can’t do here and certain implants we can’t do — like some biologicals and newer technologies — because there’s no way for us to bill for them. They become prohibitive. But as advice: use an expert.
Q: As you’ve grown, has that made it easier to negotiate with payers?
GD: Yeah, I think management companies and groups have more leverage. For example, I’m president of our Massachusetts state association, so if we go to Blue Cross as an association, that’s much more valuable than me going to an individual center.
But everyone has limitations. There may be someone who runs a center who comes from contract negotiation or worked for a payer; they might know what they’re doing. A lot of people, like myself, are mainly of clinical background and learned business over the years, but I don’t have the negotiation tactics professionals have.
