The evolving ASC reimbursement landscape — 3 Qs with CEO Dr. Joe Smith

Reflexion Health CEO Joe Smith, MD, PhD, spoke to Becker's ASC Review about the evolving healthcare reimbursement landscape.

Note: Responses were lightly edited for style.

Question: What are the biggest payer and reimbursement changes your ASC customers have experienced over the past two to three years? Are you seeing more risk-based contracts or price transparency in your market(s)?

Dr. Joe Smith: ASCs are dealing across a continuum — some are aggressively seeking risk-based contracts as they understand their businesses and see great opportunities to drive efficiencies and margin, while others are doing their homework now and getting ready for value-based/at-risk contracts in the near future. There is a growing and general appreciation that payers are moving away from fee for service, and the forward-thinking ASCs are looking to capitalize on this trend.

Q: Are you seeing more patients with high-deductible health plans in your market(s)? What is your strategy for working with those patients?

JS: Our solution is focused on keeping the patient at home, which means fewer outpatient visits, greatly decreased transportation costs and much less face-to-face clinic care. We encourage our clients to offer VERA at zero cost to the patient, therefore it doesn't apply to their deductible and avoids the out-of-pocket expenses that too-often [are] a barrier to care.

Q: How do you approach payer negotiations? What are your top pieces of advice to make sure they're successful?

JS: Payers today are transitioning on the quadruple win: enhancing patient experience, improving population health, reducing healthcare costs and improving the work life of healthcare practitioners. We focus on all four, which is key to our success.

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