How ambulatory surgery centers can leverage payers into mutually beneficial contracts was among the topics of discussion during a Q&A discussion at the Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs conference, which was held Oct. 18-20 in Chicago.
Kayla McCann Mary, an associate at Chicago law firm McGuireWoods, spoke with Matt Kilton, an associate principal at ECG Management Consultants, about payer contracting and other issues ASCs may face.
Here are two highlights from the discussion:
1. Mr. Kilton discussed the new roles ASCs are taking to improve their leverage when negotiating with payers. He said more ASCs are approaching negotiations with the idea that they can choose to go out of network with an insurer if their interests do not align.
"We're seeing more opportunities for outpatient centers, [but] we aren't necessarily seeing payers come [into the equation] as partners. I would say that over the past three or four years, what we've seen … [is] that out-of-network option [for ASCs]," Mr. Kilton said, adding that ASCs have begun "approaching contracting [with the idea] that they have options to leverage payers" by choosing to go out of network if the payer contract does not suit their needs.
2. In terms of bundled payments, Ms. McCann said it is important for ASCs to scrutinize which physicians or services are included in each bundled payment, and ensure the other party is benefiting from the arrangement as well.
"You have to be very, very careful about how you're selecting who's going to be on your bundle and that the people you're potentially selecting for the upside of the bundle are also sharing in the downside of the bundle. Just like when you invest in a business or invest in a surgery center, you're taking a real risk with your money, and that aspect is very, very important when you take a look at the overall arrangement," she said. "It could be true that someone in the risk-sharing seat of that bundle could get less money [by participating in the bundle] than they could have otherwise, by participating in a fee-for-service model or something else."