Administrator of Hoffman Estates, Ill.-based Ashton Center for Day Surgery Alfonso del Granado discusses key trends in the reimbursement landscape and how high deductibles have become the norm.
Question: What changes have you seen in payer coverage at your ASC over the past few years? Are you anticipating any other changes for 2019?
Alfonso del Granado: High deductibles have become the norm, but otherwise no changes. Generally, the specifics of a given contract tend to outweigh the broad strokes.
Q: How is your center dealing with the trend of higher deductibles and increased patient responsibility?
ADG: We request payment upfront for the entire deductible, though we do make limited exceptions and sometimes offer short-term payment plans — three to six months — if placed on auto-pay with the patient's credit card. We have also had to contract with most big payers because the out-of-network deductibles are impossible for patients to afford.
Q: As payers consolidate, and make acquisitions of healthcare providers, where do you see ASCs having the biggest opportunity to succeed?
ADG: Workers' compensation and personal injury are still reasonable payers, so pain, orthopedics, spine, podiatry and hand surgery are good specialties to pursue.
Q: Are you engaged in any alternative payment models and how do you expect APMs to evolve in the future?
ADG: We do participate in a couple of bundled payment programs and have done some cases, but it is difficult to discern which programs are likely to produce results. It seems most are still building their networks and have little to offer in terms of volume. Given that, I strongly recommend not signing any exclusive agreements or at least including an early termination clause if sufficient volume does not materialize in a reasonable time frame.