As reimbursement pressures mount and payer strategies evolve, ASC leaders are keeping a close eye on how these changes may impact operations, revenue and patient care.
From value-based care initiatives to reimbursement cuts and claim denials, two ASC leaders joined Becker’s to discuss the payer trends they’re keeping an eye on.
Question: What payer-related trend are you monitoring most closely right now?
Editor’s note: These responses have been edited lightly for clarity and length.
Paula Autry. CEO of Leadership DNAmics (Grass Lakes, Mich.): The payer-related trends I am monitoring are initiatives that can result in meaningful improvement in the delivery of healthcare services and advance the health status of our communities. Those initiatives include:
- Promoting value-based care by alignment with physicians, health systems, employers and communities. The goals are to encourage accountability between patients and providers to provide efficient, high-quality care.
- Improved customer service and efficiency of service. Encourage continuous input from consumers and providers to identify areas of improvement to correct and monitor.
- Continued enhancement of technology to improve processing of authorization and payments. The pre-authorization and authorization process by payers has been identified as a major source of frustration for patients and providers. I am monitoring continued improvement in the processing of authorization and timeliness of payments to ensure needed procedures are provided timely and payments are handled quickly to ensure liquidity of health systems.
- Increased use of data, A1 and bio engineering, to conduct risk-stratification to improve prevention and treatment of illness and injury.
- I am following payers closely to assess if they establish ways to align to ensure the U.S. healthcare system has the highest health outcomes with the most efficient services in the world. Ultimately, I am aligning to ensure that we can transform our health delivery system into one that accelerates innovation by including patients and providers at all levels in the transformation of services.
Alejandro Fernandez. CEO of Synergy Orthopedic Specialists (San Diego): I closely monitor declining reimbursement rates from Medicare and commercial payers — this is expected to continue in 2025 and directly impacts our revenue.
Also I keep an eye on:
- Shift to outpatient and ASCs, as payers push more procedures to these lower-cost settings, often tied to bundled payments.
- Increasing claim denials and delays, making efficient billing and collections crucial.
- Market pressure for consolidation to gain negotiating power with payers.
Staying ahead of these trends will help me protect our margins and keep Synergy Orthopedic medical group competitive.
