Higher acuity cases provide additional volume – because higher acuity surgeons, such as joint and spine surgeons, aren’t yet affiliated with outpatient centers – and also help drive profits through higher reimbursement than traditional ASC cases.
To attract these higher acuity cases, surgery center leaders should reach out to joint and spine surgeons and educate them on the advantages of ASCs. “These are the surgeons that have not yet shifted their care from the hospital setting to the surgery center setting,” he said.
Some of the key benefits he touts to potential new partners include:
– Lower infection rates than the hospital setting
– Highly proficient specialized staffing
– High patient satisfaction scores
– Opportunity to share in profits on facility fees
Another first step to prepare for higher acuity cases is to ensure your center has an anesthesia provider comfortable with overseeing pain management for more complex cases.
“Anesthesia must plan for post-operative pain control for 3-plus days,” Mr. Bishop explained. “When you start dealing with higher acuity care, anesthesia really becomes a true partner in the care in your facility,” and can’t be seen as a commodity.
After clinicians are on board with the move to higher acuity case, the next step is working with commercial payers to negotiate a contracted rate for the higher acuity cases, which may include unicompartmental knees, spinal fusion and discectomies, to name a few.
The lower-cost site of care of ASCs is a major advantage when negotiating with payers. For example, a facility fee for a lumbar microdiscetomy in a hospital ranges from around $7,000-$24,000, while the facility fee for an outpatient center ranges from around $2,500 to $11,500.
If your center is the first in a market to perform outpatient spine, Mr. Bishop recommends having surgeons interact “peer-to-peer” with the insurer’s medical director and finding other markets where the payer is reimbursing higher acuity outpatient procedures and making the connection for the medical director.
While it is up to each surgeon whether or not each patient is a candidate for a higher acuity outpatient procedure, the lower infection rates, lower costs and ability to partner with other providers, such as home health, for extended care after the patient is discharged, make ASCs an increasingly attractive setting for many joint and spine procedures.
