How ASC leaders, physicians are navigating payer relations in 2024

The ever-changing payer landscape requires leaders to be nimble in order to navigate it successfully.  

Here's how three ASC leaders and physicians are navigating the evolving payer landscape:

Editor's note: These responses were edited lighty for length and clarity. 

Reuben Gobezie, MD. Director of the Gobezie Shoulder Institute in Cleveland: Incorporate our ASCs into our overall practice strategy to provide risk-based contracts to payers and employers in order to reduce their total cost of musculoskeletal spend. We are using provider-based technology platforms … to enable our practice 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. Surgical procedures are amongst the most expensive services MSK practices provide, and the ASCs are an ideal ancillary to leverage in any strategy to reduce the total cost of care for musculoskeletal care.

Andrew Lovewell. CEO at Columbia (Mo.) Orthopaedic Group: 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. 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. I am also looking for steerage from the payers for ASC strategies in our market. As the low cost/high value provider in the market, we should see significant streerage to our facility but have not experienced that yet. With our clinical outcomes both surgically and non-operatively, we are the best value around.

Timothy Lubenow, MD. Professor of Anesthesia and Pain Medicine at Rush University Medical Center (Chicago): I'm planning to improve my payer mix by networking with workers' compensation nursing organizations. I also am limiting the number of Medicare patients seen on a daily basis.

Read more about the trends ASC leaders are watching here.

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