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The future of ASC payment models & the shift to value-based care

The healthcare delivery model's shift toward value-based care from fee-for-service has raised important questions for ASC payment models.

As adjudication technology, potential market disruption and other barriers emerge, ASCs must continue to optimize performance in a fee-for-service world. A panel at Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs in Chicago, Oct. 18-20, further emphasized gradually changing strategies and operations in preparation for value-based reimbursement over time.

Here are three key takeaways:

1. Slow progress toward a healthcare delivery model change. Max Reibolt, CPA, president and CEO of Atlanta-based Coker Group, explained that while there is a current shift from fee-for-service, it has been slow, and the payment model still dominates the healthcare and ASC payment systems.

"My perspective is that everywhere we go there is some interest [in value-based care], but for the most part we're still in a fee-for-service environment … Maybe the dial is moving a little bit further to some form of quality and value-based reimbursement, but I think the more important point is that there are some nuances for fee-for-service reimbursement, particularly in the ASC realm."

2. Defining value-based care. While the definition of fee-for-service undergoes slow changes, Barry Tanner, president and CEO of Physicians Endoscopy in Jamison, Pa., pointed out that value-based care is not so clear cut or advanced as it may seem. Mr. Tanner agreed that the payment model appears to be the buzz of every meeting, but when looking across the healthcare spectrum, it's as though, "we're only on step one, two or three of a 20-step program," when implementing value-based care.

Within the gastrointestinal sector, Mr. Tanner said the industry is beginning to see a lot more programs designed around value, but there is a lack of commitment as to how that value is going to be paid for.

3. Adjudication technology as a barrier to value-based care. When considering the shift toward value-based reimbursement, it is important to remember that legacy systems are not designed to handle payment structures beyond fee-for-service. Bundle payments or outcomes incentives are still not widely available because of the lack of technology to process the payments. Mr. Tanner attributed this technology piece as one of the aspects that slowed down the trend toward bundling because it creates a high-risk of payment duplication.

"Most of the legacy systems that are all fee-for-service based do not have the guardrails to prevent one of the providers in [the payor's] bundle if they accidentally, or through oversight, submit a separate bill for that same procedure that ends up back with the payor. They don't have a good way of filtering out that [payment] as a duplicate."

More articles on coding, billing and collections:
4 lessons from an analysis of general surgery billing denials
Maximize your 2018 reimbursements: Know your health plans, know your market, and stay on top of trends
Alternative payment models strain physician practices — 6 study findings

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