The days of easy negotiations for ambulatory surgery centers to make significant year-over-year increases are in the past. However, there is some good news: increased awareness of the ASC business model allows owners and operators to have deeper discussions with payers.
"Over the years, our industry has demonstrated success in moving service lines from the hospital to a freestanding outpatient setting," says Lindsay Haynes Lowder, director, managed care at Surgical Care Affiliates. "From lithotripsy in the nineties to spine procedures in the more recent past, ASCs have built a strong history around high quality/lower cost."
Data on the quality of care patients receive at ASCs allows for the continued migration of once-thought "hospital-only" procedures into the outpatient setting. Payers are now open to discussion about additional new procedures transitioning into the ASC setting.
"Getting the payer and their medical directors comfortable with the clinical component of shifting new cases to an ASC is always, and should be, paramount in these cutting-edge discussions, but because of the solid foundation our industry has built over the years the door is open to begin that conversation," says Ms. Lowder. "While some payers will always be more open to being early adopters of shifting high acuity cases to an ASC, the majority of the payer community understands and accepts it is in the best interest of many involved — payers, employers, patients and ASCs — to have these procedures performed in a high quality, lower cost environment."
Five years ago, there were certain markets at the forefront of shifting anterior cervical discectomy and fusion into the outpatient setting. Now, it's becoming an expectation.
"Getting payer approval for those procedures in an ASC and setting an acceptable rate still requires a more in-depth conversation in some markets, but Medicare's recent approval of a number of spine procedures for performance in an ASC shows how that boundary keeps progressing as clinical standards of care and technology evolve," says Ms. Lowder. "In many markets, our conversations today around performing total joint replacements on an outpatient basis are greeted with interest and careful consideration as payers explore this opportunity for their members."
There are also ways ASCs are partnering and aligning with payers. SCA centers are working with payers to shift care into outpatient settings with several strategies:
• Developing a program to incentivize bringing cases to the low-cost setting
• Allowing facilities to add new service lines
• Helping payers to market outpatient surgery in the low-cost ASC
"SCA is constantly seeking out strategic conversations about partnerships and how we can work together to shift care to the optimal setting," says Ms. Lowder. "As deductibles continue to increase, patients are clamoring for more information so they can make more informed decisions about their healthcare as they take on more of these costs. Price transparency tools are now becoming the norm with the large payers and members starting to be motivated to use them since the dollars they are spending are more frequently coming out of their own pocket."
Not all patients are using price transparency tools regularly, but when they do, they'll demand insurance companies to share more data about cost and quality to help them make individual healthcare decisions. "As the optimal site of care in many markets, ASCs are well positioned for this increased transparency," says Ms. Lowder. "Educating the patients on the lower cost/higher quality alternatives available is a boon for our industry as a whole."
ASC owners and operators can also use the data during payer negotiations.
"Our job in these conversations is to help the payer see the advantages of working together to bring the appropriate cases to the center," says Ms. Lowder. "It requires a more robust conversation, but the potential for ASCs to shift relationships with payers, and by extension with patients, to be a true partnership is really exciting."
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