How the payer landscape is changing for ASCs: Key thoughts from Administrator Benita Tapia

Beverly Hills, Calif.-based 90210 Surgery Medical Center Administrator Benita Tapia discusses how the payer landscape is changing and how her center improves the patient experience.

Ms. Tapia will speak at the Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs, October 18-20, 2018 in Chicago. Click here to learn more and register.

Question: How have you seen the payer landscape change over the past three to five years? What trends are you preparing for in the future?

Benita Tapia: There has been a tremendous change in the payer landscape and value-based care is definitely the trend. Payers are making it difficult for ASCs to sustain out-of-network, and we are seeing max per day rates on OON cases some as low as $350 with some paid at a percentage of Medicare, which means larger deductibles and a larger coinsurance that the patient has to pay. This makes it not cost effective for the patient or the ASC to do the case OON.

We are seeing more and more bundled payments and incentives for surgeons to bring eligible patients into the ASC environment, and payers are sometimes stating if the patient is eligible, to go to the ASC for some procedures. The procedure may only be reimbursed in the ASC and not the hospital environment. I would predict that in the future we will see more incentives for the patient to go to an in-network facility, especially if the bundled payment methodology is chosen. There would be less deductible and copayments for the facility and increased reimbursement for physicians using the in-network facility and participating in the bundled payment methodology.

Q: What is the smartest thing your ASC does to improve the patient experience, beyond the typical advantages an ASC has over the hospital?

BT: Patients tell us over and over again they feel like they're given a more personal experience. Hospitals are usually extremely large and the patient has to encounter a multitude of different people. It can be overwhelming for patients navigating through a large hospital just to check-in for their procedure. In the ASC environment you often find staff wearing many hats, you may find the pre-op nurse that took care of the patient will be there to greet the patient in the post-anesthesia care unit after the case, which provides a continuity of care and a personal bond between the patient and the nurse. The long wait in hospitals of cases getting delayed and rescheduled because of emergencies can cause anxiety. The patient can be left NPO and anxiously waiting for their procedure and the operating room to become available. Usually cases go more true to time in an ASC environment.

Q: Over the next two to three years, what is the biggest opportunity for ensuring profitability at your ASC?

BT: Anticipating the changing landscape of value-based care. Keeping costs down, for example trying to have surgeons use the same vendor for implants, etc. Volume allows for you to have increased buying power, so it's important to maintain and increase volume. Surgeons taking blocked time can help with staffing costs.

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