At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 14, Naya Kehayes, managing principal and CEO, and Michael McClain, manager, of Eveia Health Consulting and Management, explained the background of spine and orthopedics cases and how ASCs can bolster their payer contracting with those two specialties.
For ASCs that are considering adding complex orthopedic and spine cases — such as anterior cervical discectomies, laminectomies, rotator cuff repairs and some total joint reconstructions — Mr. McClain said a lot of research and homework must be done. Administrators must do a cost analysis of cases they want to add, collect data on all capital and operational costs and compare hospital reimbursement of these cases to ASC reimbursement. Then, they must present this data to payers during negotiations and demonstrate how they can save payers money, he said.
"It's key to understand [spine and complex orthopedic cases] beforehand," Mr. McClain said. "How much time is this going to take in the OR? What are the capital considerations? The cost of setting up a program is absolutely negotiable."
When ASCs are able to demonstrate cost savings to payers, that is where conversations are won, Ms. Kehayes said. Hospitals charge much more for spine and orthopedic cases compared with ASCs, and she said if ASCs can show 25 to 30 percent cost savings compared with the hospital, they will win the attention of payers.
"The more dominant the market is with hospitals, the more that you will present a bigger opportunity to the payer," she said. "If you can demonstrate a significant savings even on low volume, it could be a really meaningful conversation with the payer. But presenting the data to demonstrate savings is absolutely critical."
For ASCs that are considering adding complex orthopedic and spine cases — such as anterior cervical discectomies, laminectomies, rotator cuff repairs and some total joint reconstructions — Mr. McClain said a lot of research and homework must be done. Administrators must do a cost analysis of cases they want to add, collect data on all capital and operational costs and compare hospital reimbursement of these cases to ASC reimbursement. Then, they must present this data to payers during negotiations and demonstrate how they can save payers money, he said.
"It's key to understand [spine and complex orthopedic cases] beforehand," Mr. McClain said. "How much time is this going to take in the OR? What are the capital considerations? The cost of setting up a program is absolutely negotiable."
When ASCs are able to demonstrate cost savings to payers, that is where conversations are won, Ms. Kehayes said. Hospitals charge much more for spine and orthopedic cases compared with ASCs, and she said if ASCs can show 25 to 30 percent cost savings compared with the hospital, they will win the attention of payers.
"The more dominant the market is with hospitals, the more that you will present a bigger opportunity to the payer," she said. "If you can demonstrate a significant savings even on low volume, it could be a really meaningful conversation with the payer. But presenting the data to demonstrate savings is absolutely critical."
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