ASC profitability hinges on case-costing metrics, one administrator says

Patsy Newitt - Print  |

The challenge of covering implant costs and keeping up with payer regulations makes maintaining profitability tricky for many independent ASCs.

Becky Ziegler-Otis, administrator of Ambulatory Surgical Center of Stevens Point (Wis.), spoke with "Becker's Ambulatory Surgery Center Podcast" on the biggest issues affecting her center. 

This is an excerpt. Download the full episode here

Editor's note: This interview was edited lightly for brevity. 

Question: What are the biggest issues affecting your ASC currently?

Becky Ziegler-Otis: Well, there's a lot of issues that I would say keep me up at night, and pretty much the biggest ones all center around what I would refer to as financial viability and profitability of the center. 

As an independent center, it's critical that I have to stay abreast of the payer reimbursement trends and also what the cost of the care is that we provide. It can really be a challenge to get adequate reimbursement from commercial payers, even if they know that we provide great value to consumers. Through my tenure as the ASC administrator, I've seen so many changes in the payer reimbursement landscape from the commercial and the government side.

We have to be really careful with our case selection to assure cases we perform are adequately reimbursed and that the costs are covered by the revenue before we even placed them on our surgery schedule. I pay very close attention to case costing and the reporting metrics in this regard. And that, to me, is how we continue to survive and thrive in the ASC market. 

We are also an ASC that's very heavy in orthopedics. And so I believe we had the added challenge of making sure that we're covering the cost of our implants. An ongoing issue is to ensure we're getting the best pricing for our implants, but also it requires our payer agreements to be properly structured — to either carve out or pay the cost of the implant separately and make sure it's adequately covered in the facility fee if they aren't going to carve it out.

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