Advice for new ASC administrators from Simplify ASC's DeeDee Dalke


DeeDee Dalke, former ASC administrator and consultant for ASC management software developer Simplify ASC, discussed a new proposed CMS rule and advice for new ASC administrators.

Note: Responses have been edited for style and clarity.

Question: What’s your reaction to the recent news from CMS?

DeeDee Dalke: I’m excited to see total knee arthroplasty made it on the approved codes list, along with the other seven codes.The decision regarding six potential spine codes moving off the inpatient-only list is interesting. A lot will depend on how patients will do in an outpatient hospital setting first. In the long run, I believe we’ll see these procedures in the ASC setting just as we are now seeing some total joints on the approved list. We’re watching total hip replacements as well. The lower cost for patients and higher case volume/increased revenue for ASCs are good news for everyone involved.

Q: What changes to the OPPS are you most looking forward to?

DD: The proposed ASC updated payment rate increase this year to 2.7 overall from 2.1 in the previous year is good news for all ASCs. But, given that there are more complex procedures added to the approved list, I was surprised there were not more quality measures announced, and more interest in tracking outcomes data. I would imagine that’s coming in the future.

Q: Where do you think the ASC industry will be in the next three to five years?

DD: There will be a continuation of procedures moving from inpatient-only status to ASC. With more ASCs adding total joint programs to their facilities, we’ll see more multispecialty ASCs along with more quality data measures. The increased reimbursement from higher case volume is great, but ASCs should proceed carefully. Rising operating expenses mean careful case costing and budgeting will need to be in place to reap the most benefit from the increased reimbursement.

Q: What advice would you give to new ASC administrators?

DD: Keep up to date on CMS regulations as well as accreditations, such as AAAHC and the Joint Commission. Take CMS quality reporting participation and its 2 percent reduction in reimbursement if the center opts out seriously. When a new CMS quality measure is announced, ASCs should be ready to update their forms to capture the necessary data, or run the risk of losing that 2 percent of reimbursement. The same holds true for infection control measures and 23-hour stay requirements. Discuss these CMS proposal/final rules with your board members. Have a good system in place that will allow you to analyze expenses and reimbursement. Proper case costing and proper reporting of quality measures become even more important in a more complex care environment. See this blog post for more information.

Q: Can you speak a little about the role of in ASC payments, and the challenge that comes with price transparency efforts?

DD: While it’s true that more employers and employees are choosing these plans for the more affordable premium, patients struggle to pay their outstanding high deductible amounts up front. More facilities will likely be adding payment plans to their financial policy, if they haven’t already. In addition, ASCs may see increases in delinquent patient payments or refusal/inability to pay. ASCs should think about offering financial counseling to patients regarding their planned procedures and provide estimated procedural costs prior to the day of surgery.

As for price transparency, patients will have access to procedure charge information, but this becomes difficult when the posted charge information on the website does/may not include all the background information like ASC contracts with insurance companies (example: multiple procedure discounts). Patients need to view the price transparency tools on an ASC website as a start, because there’s so many pieces to put together in the estimate: CPT codes, possible implant codes, insurance contracts and patient benefits. ASCs should make sure financial departments are adequately staffed and trained to give patients the full financial picture.

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