Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Implant costs vs. ASCs: How 1 management company leverages payer contracts

Listen
Text
  • Small
  • Medium
  • Large

As higher-acuity procedures move outpatient, independent ASCs could have difficulty securing reimbursements. 

Joseph Zasa is the managing partner and founder of ASD Management, which manages outpatient multispecialty and single-specialty ASCs. He joined "Becker's Ambulatory Surgery Centers Podcast" to discuss payer-ASC relationships. 

This is an excerpt. Download the full episode here.  

Editor's note: This interview was edited lightly for clarity and brevity. 

Question: What are the key trends you're following in outpatient surgery? 

Joseph Zasa: We're seeing more cases move toward ASCs, and how the payers are reacting to that is very interesting. Most of our surgery centers are hospital-physician joint ventures we manage for health systems and physicians. Specifically, we're seeing orthopedic joint surgery — total knees, total hips, total shoulders — moving to an outpatient market.

These are higher-cost cases, but they're also potentially higher-margin cases. And because we're dealing with expensive implants, it's a very different discussion we're having with the payers. That is the hot discussion area going on between ASCs and third-party payers. 

Q: Are payers becoming more receptive to ASCs?

JZ: We've always said that healthcare is a local business, and each market is different. However, we're seeing the big payers roll out national contracts. They're more of a regional-type contract where that payer has a large segment of the market and is trying to move everybody to the same general rates. One of the things that we feel is part of the discussion with the payers is to say, look, this is a win-win for both parties. These cases are moving out of the hospital. You're paying typically two to three times more in the hospital.

But if you go to a market and you just have a surgery center, rather than a hospital-physician joint venture, the payer is looking at a much bigger picture. The surgery center carves out a small piece of a much larger pie, and you see a lot more payer resistance under that type of scenario. But when you're working in conjunction with your hospital partner, you tend to get better results.

Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast