Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and vice president of the New York State Association of ASCs, joined Becker’s to discuss how deeper collaboration between payers, providers and ASCs could improve the prior authorization process and reduce care delays.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What could meaningful collaboration between payers and ASCs look like in practice, in an ideal world?
Elisa Auguste: I don’t think it’s just ASCs and payers. It needs to be ASCs, payers and providers. Payers want to push cases to ASCs — they’ve been instituting policies for years. Blue Cross Blue Shield was one of the first; they stopped approving certain elective cases in hospital settings because they wanted them moved to ASCs.
I think what it comes down to is navigating the prior authorization process: understanding why it’s in place, looking at different surgeries, and reviewing the conservative treatments payers expect. If a patient isn’t going through those steps, we need to medically justify why — what’s the reasoning?
For peer-to-peers, it’s important to align by specialty — ortho to ortho, GI to GI — so the reviewer understands the clinical perspective.
That’s why I say it’s a three-way mix. The ASC is just the location — we’re cheaper than the hospital. But this is really about the provider and the payer. The current process punishes patients with delayed care, and it punishes providers who spend time fighting for approvals and hitting roadblocks.
There needs to be a better system. I know Texas has discussed a “gold card” model, where if a provider has a good track record with prior authorizations, they don’t have to keep going through the process. I’m not saying that has to be the standard everywhere, but it’s one example of collaboration.
If payers can say, “We trust this group. We know you won’t abuse the system,” then you can minimize delays in care while keeping guardrails in place for the small minority who do abuse it.
