John Lewis, CEO of the Memphis-based Semmes Murphey Clinic, a practice specializing in treating illnesses related to the nervous system, weighed in on the top payment challenges for ASCs.
Note: Responses have been edited for style and content.
Question: What reimbursement trends are you noticing in your market?
John Lewis: Although many of our reimbursement agreements are fee-for-service models, we are seeing a definite shift toward value-based arrangements. We have been actively involved in developing value-based bundles in a Center of Excellence model that are more cost-effective and emphasize the quality of the work that our clinic performs. We have collaborated with providers (anesthesia and others) in a way that makes it easier and more cost-effective for patients and payers. Our patients have also indicated that they are highly satisfied with our use of nurse and patient navigators, and employers like having defined costs and quicker returns to work. Our experience indicates that our practice will need to continue moving in this direction in the future.
Q: Are payers becoming more willing to negotiate with ASCs in your market?
JL: I think payers are more willing to negotiate with us knowing that we can provide value-based care options. Our value-based model of care includes not only cost savings but higher quality outcomes and quicker recovery times. One of the unique things about our practice is that we are one of the largest contributors to the quality outcomes database spine registry which serves as a continuous national clinical registry for the most common neurosurgical and spine procedures. This has given us the ability to not only negotiate with third party payers, but we are also able to identify practice gaps through established benchmarks, meet merit-based incentive payment system reporting requirements and be a part of structured quality improvement projects.
Q: What would the ideal payer mix be for your center?
JL: I think the ideal mix is a blend of numerous commercial carriers with comparable market share, some volume of government payers and a consistent workers compensation patient population. We try to participate with all carriers to come as close as possible to this balance. This is not always possible, as not all payers are willing to contract for the full spectrum of services we provide.