When you have the concept of [building the ASC], before you even put that first shovel in the dirt, you need to have already assessed the payor environment in the locale you are considering. You need to have somebody starting the conversation with the payors and keeping in touch with them on a regular basis. If you know they have closed their network and are not admitting new providers (or facilities), you can’t just hope for the best. That would be disastrous. Actual negotiations can take up to several months. While your contracts may not go into effect until after you have received your state license and Medicare certification, you have to have all of your paperwork completed prior to those surveys if you expect services to be covered by payors when you actually open for business.
You really have to analyze your book of business to ascertain which types of procedures should be carved out. You need to address implants as well. What we’re seeing is a lot more physician/hospital joint-venture ASCs. Your hospital partner relationship should be used to leverage contract negotiations. In situations where you don’t have a hospital partner, take into consideration what your volume is [or is projected to be], then determine if your physician providers are part of the payor network for the professional side, then enlist physician support in using their current contracts as leverage to secure ASC contracts.
Learn more about Pinnacle III.
