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Employers, fed up with insurance companies, turn to ASCs

Employers are increasingly interested in direct contracting with surgery centers through regional and national contracts, and ASCs are ready partners as high quality, low cost sites of care.

"As the cost of healthcare benefits for employees continues to rise, we are seeing continued requests for contracts that allow employers to provide high quality care services to their employees at a significant cost savings to the employer," said Mike Grant, administrator of Surgery Center of Amarillo (Texas).

Direct-to-employer contracting can provide an additional revenue stream for physicians and surgery centers, especially if commercial payers are narrowing their networks and lowering reimbursement rates.

"ASCs that have an ability to bundle their services for specific procedures will have the opportunity to negotiate directly with self-insured employers, enabling their employees to get concierge-type services at reduced rates. By doing so, employers will reduce their loss time injuries and ensure that their employees receive high quality services in a controlled environment," said Christina Goodall, RN, DNP, administrator of Atlanta Orthopedic Institute.

Nader Samii, CEO of National Medical Billing Services, and Alison Kuley, senior spine coder at the company, advised ASCs to enter into direct-to-employer contracts with specific companies to drive more spine surgeries to the facility in a September 2020 Becker's article. They said ASCs could approach large employers with a discount for employees in exchange for encouraging employees to select the center.

"Given the significant cost of spine procedures, this will be very attractive to employers and will provide employees with a high-quality destination for their surgeries," they wrote.

National ASC chains are also engaging in direct-to-employer contracts. ValueHealth, which has a network of ASCs across the U.S., offers a program to employers, SurgerySavings, to provide surgery for employees. The company claims to provide more than $10,000 in savings per episode of care on high-value procedures.

Dallas-based United Surgical Partners International executives are in the early stages of developing direct-to-employer, value-based contracts for its surgery centers.

"It brings USPI centers and doctors' patients from distant geographies based upon employers that are looking for high quality and high values," said Saum Sutaria, president and COO of Tenet, USPI's parent company, during the first-quarter earnings call April 21.

The American Medical Association recommends physicians entering into direct-to-employer contracts make sure contract language is clear that employers control the plan, but not the practice of medicine. The contract should also cover data-sharing and stewardship, compensation, patient privacy and expected timing for progress reports.

 

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