ASCs sharpen strategies to combat payer behavior

ASCs are facing obstacles from payers in many markets to receive the reimbursements leaders say are needed to meet margins. Here is how many leaders are shifting their strategy.

1. Reevaluating contracts

ASCs are focusing on reevaluating payer contracts to stay ahead of potential reimbursement declines, particularly with a rise in denials for Medicare Advantage members. 

"With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we re-examine our payer contracts with all other payers in our market," Andrew Lovewell, CEO at Columbia (Mo.) Orthopaedic Group, told Becker's. "Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC."

2. Focusing on risk-based contracts

Reuben Gobezie, MD, director of the Gobezie Shoulder Institute in Cleveland, told Becker's his growth strategy includes incorporating ASCs to his organization's "overall practice strategy to provide risk-based contracts to payers and employers in order to reduce their total cost of musculoskeletal spend."

This strategy includes using provider-based technology platforms to "leverage all of its services to the payers and self-insured employers who are desperately seeking ways to reduce their ever-increasing MSK spend."

Because ASCs specialize in providing lower-cost procedures, they can be used as leverage in contracts, Dr. Gobezie said. 

3. Capitalizing on value-based care 

Value-based care can benefit physicians and patients, according to a November report from Humana, and some ASC leaders say value-based care will be the key to future success.

"As healthcare reimbursement models shift from fee-for-service to value-based care, ASC leaders must focus on delivering high-quality outcomes and patient satisfaction," Ali Ghalayini, administrator at Munster (Ind.) Surgery Center, told Becker's. "Centers that can demonstrate efficient and effective care delivery while maintaining excellent patient experiences will likely be rewarded." "Therefore, tracking and improving key performance indicators such as infection rates, patient-reported outcomes, readmission rates and patient satisfaction scores are essential. Collaborations with payers and accountable care organizations to align incentives and performance goals can be advantageous."

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