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The do's & don'ts of ASC price transparency: 3 Qs with Ohio Surgery Center administrator Suzi Walton

One of the key steps to implementing a successful price transparency plan is to just start somewhere, according to Columbus-based Ohio Surgery Center administrator Suzi Walton.

Here, Ms. Walton shares the story of why Ohio Surgery Center adopted the BuildMyBod price estimator app developed by California plastic surgeon Jonathan Kaplan, MD, which includes private insurance and fees to make price transparency more comprehensive.

Note: Responses have been lightly edited for style and clarity.

Question: Knowing what you know now about price transparency, what advice would you give to other centers who want to adopt it?

Suzi Walton: As far as the electronic piece of it, my advice would be to just start somewhere. I think all of us in the ASC world like to have the perfect product and the perfect plan — we get grandiose in our thought processes and it cripples us from moving forward. If I could go back and talk to myself or someone else, I would say "just start." Start with one payer, start with one procedure, add it from there. Start with just the facility if you can't get buy-in from the other players involved to start, and scale it from there. Being able to scale it adds value because then if you learn from the mistakes you're making, you can tweak it on a small scale and not make a mistake on a big scale.

I would also recommend to under-promise and over-deliver. If you're doing estimations, and three different CPT codes for something and they pay at different rates, use the highest rate that has the highest allowable regardless. Round up and use the highest one because then patients are going to be pleasantly surprised if it costs less.

Q: What would you say are some do's and don'ts of price transparency policies?

SW: Definitely do protect your contracts. Then, you're not going to be in breach of a contract where a payer is going to come back and say you're sharing your contract everywhere.

● Do talk to your payers in advance. Most of the big payers have price transparency initiatives at least on paper that they're trying to tout because they know it's the buzzword right now. Involve them in the process.

● Do also use actionable data; you definitely don't want to use bill charges.

● Do document the information you're giving to the patient. That's one nice thing about BuildMyBod; you get a copy of what the patient got. Even if they do it on midnight Saturday night, you're getting the email that shows exactly what they put in. Whether they're an existing patient or a lead, you know what information they were given.

● Do also make sure you update your website when your contracts change. If you have annual escalators built in, be sure you're going back and updating that information.

Q: How does the lead generation aspect of BuildMyBod work?

SW: The first thing we do when receiving an alert is we go on and check to see if they're on our surgical schedule already. If they're on our surgical schedule, they've just gotten ahead of us. Those we just somewhat leave alone because we're going to be calling them to go over the insurance benefits and we'll mention it at that time.

If they're true leads and they're not on a surgery schedule, we actually reach out to them and we'll bring up that they were interested in the pricing of a particular procedure, asking if we can answer any additional questions. We don't do it as a sales pitch, we just ask questions and offer help. What we've found out from the leads we've had in the past couple months is most of the people have found out from their primary care provider or pediatrician that themselves or their child is being referred to an ENT at some point because they need their tonsils taken out, or ear tubes put in. They're probably the people who are on the front line of consumerism where they're going "oh my gosh, I don't know if I can afford this," and researching the procedure to see what it involves.

I think there's a minority who are shopping around right now, but I think that tide is going to turn soon. So far, everyone has been super receptive to us when we've called and offered help, and really appreciated being able to get the information on the fly.

To participate in future Becker's Q&As, contact Rachel Popa at rpopa@beckershealthcare.com.

For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.

More articles on coding, billing and collections:
How embracing price transparency helped Ohio Surgery Center generate leads: 3 Qs with administrator Suzi Walton
Generational trends in ASC care
5 ways ASCs can improve & benchmark revenue cycle key performance indicators

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