Payer behavior continues to be one of the biggest challenges facing ASCs and other outpatient facilities.
As reimbursement pressures mount, ASCs are exploring new partnerships to improve care coordination and drive efficiencies. But without meaningful engagement from payers, progress remains slow.
Alejandro Badia, MD, founder and chief medical officer of Miami-based Badia Hand to Shoulder Center, joined Becker’s to discuss how while he believes that the next major growth opportunity for ASCs lies in deeper collaboration with other outpatient facilities, payers remain disconnected.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Do you think ASCs and urgent care centers will be well-suited for the switch to value-based care?
Dr. Alejandro Badia: Absolutely. The problem is, “value-based care” is still kind of a buzzword.
And yet, there are already value-based delivery models out there in the community. In the musculoskeletal sector, it’s obvious — this provides great value because it’s less expensive. That’s the definition of value, right?
It’s also higher quality because patients are getting seen by the right provider at the right time. The challenge is getting payers to recognize that. There’s very little dialogue between clinicians and insurers, which is a real problem.
And I think some of us should be at their conferences, and some of them should be at ours, because ultimately, we all want the same thing. But right now, we don’t have that communication, and that’s a major barrier to change.
And the reality is, there’s very little dialogue between clinicians and payers. There’s something wrong with that. I think some of us should be at their conferences, and some of them should be at ours. There should be dialogue because, ultimately, we all want the same thing.
I have no doubt that people working in the health insurance industry want their insured lives — the people paying hefty premiums — to have a good experience, right? … Unfortunately, a lot of payers know that we’ll take care of the patient no matter what. They prey on our altruism. And that’s grossly unfair.
Because if we say no, that patient will most likely end up going to a hospital, where the insurance company will get hit with a much bigger bill. So, I’m wondering, Who’s going to read this, or hear one of my podcasts, or yours, and reach out to say, “Hey, how can we fix this?” Because that’s really all we need — just a dialogue. And that has been almost impossible.
Q: How do you see payer policies evolving in response to these models?
AB: I haven’t yet. But call me foolishly optimistic — I think it’s just a matter of time.
Of course, I’ve been busy as a surgeon, which has made it challenging to really expand the OrthoNOW model. But I think eventually, we’ll meet someone in that industry who truly cares and, more importantly, has the decision-making power to make even minor changes.
And that’s the real challenge, right? Finding someone with the decision-making capability not only to get us a contract but to get us a fair contract.
I’m hoping payers will eventually recognize that this is a win for everybody and start having real conversations with us and start reimbursing accordingly.
