Navigating the New Era of Surgery Center Healthcare: Q&A With Gregory Maldonado

Gregory MaldonadoGreg Maldonaldo, President of American National Medical Management discusses the biggest challenges for ambulatory surgical centers today and what administrators can do to modernize and prepare for changing healthcare laws.  

Q: What new challenges do surgery centers face in today’s market and how can they adapt to meet those challenges?

Greg Maldonado: The biggest challenge in an ASC today is reimbursement. I always recommend surgery centers hire an expert. Sometimes an individual is so close to a situation that they miss the problems and issues right in front of them or they can identify the problems but do not have the correct solutions. Bringing in an expert adds a fresh set of eyes and allows for a new perspective. Whether you choose to use an internal biller, a third party reimbursement expert or a claims management company, an ASC will always benefit from an internal self-audit at least twice a year.  

ASC owners and administrators should research innovative reimbursement companies and ask for a free consultation or business analysis prior to signing an in-network contract with insurances. Once you sign that contract, you are at the mercy of the insurance company; you will have to play by their rules and accept their fee schedules. Remaining out-of-network, knowing federal and state laws, and understanding your rights will allow you more leverage when negotiating claims. Do your homework, scrutinize the market and never settle. Remember that you are the medical expert, and you should be the reimbursement expert as well. If the insurance company is the "reimbursement expert" and you are playing by their rules, your facility is most likely receiving subpar reimbursement.  

Q: What tools do ASCs have in place and which strategies can they utilize to forge ahead as healthcare reform is implemented?

GM: Understanding the new healthcare reforms and regulations is essential; knowing how to use those laws to your advantage is the key to success. It is a hindrance to the profitability of your ASC if you are not fully versed in the Patient Protection Affordable Care Act. Most ASCs I’ve talked to don’t understand the power they have under the new laws and that is where an expert can help. First, designate an intuitive individual with ASC regulation experience to lead the research and development team. Listen to multiple ideas before forming your own strategy.  Finally, decide on a plan that is the best path of success for your individual ASC.

Great leaders constantly self-reflect. To stay on top of your industry, you have to educate yourself and understand the trends. Know what other providers are facing in your market. Reach out to other ASCs around the country to see what they are doing to remain successful. You may hear of a business strategy from another ASC that could be beneficial for your practice as well. With more information, you will be better equipped to pursue your own course of action. Stay open-minded and have a constant thirst for knowledge.

Q: What cultural trends and attitudes should ASC leaders bring to their centers for success in the future?

GM: It's an absolute striving for perfection. If you’ve ever stayed at a five-star hotel, you know the difference between five stars and four. They are similar, but the details set them apart. If leadership understands this, it will trickle down to all staff members at the ASC. If the ASC leadership exhibits a sense of excellence and has clear expectations, they will never have to lower their standards.  

People are drawn to leadership and like working in a positive, exhilarating and productive environment. The ASC is a prime setting for excellence. Imagine a situation where healthcare providers are providing great healthcare to patients, keeping out-of-pocket cost to a minimum and adding substantial profits. That is a recipe for a five-star ASC.  

Q: How do good ASCs make that transition into creating a great patient experience?

GM: It all comes down to aesthetics and fine details. I've been in ASC lobbies with a cold clinical feel, and it is not as inviting to patients. Keep your clients in mind. A warm and inviting lobby can make an otherwise daunting experience more comfortable. Treating patients the way you want to be treated improves the overall experience. The devil is in the details. Remember that the smallest change can make the biggest difference.  

Always find ways to continuously improve. When it comes to surgery, the patient wants to feel comfortable and know that they are getting the best care possible.

Q: How can ASCs ensure they will be adaptable for change in the future?

GM: ASCs have to optimize reimbursement and create an internal culture of success. Build relationships with likeminded out-of-network providers and appoint patient liaisons who specialize in customer service. If you can educate the patient on what the ASC is trying to achieve — to be the best — patients will be more proactive in offering feedback. Most people are non-confrontational, but if you invite them to offer constructive comments, they will help you. Educate staff on ways to welcome and elicit real feedback, in lieu of a generalized survey.

Reimbursement should always be at the forefront of ASC success. Ideally, you want a profitable surgery center so owners have the ability to award quarterly bonuses to their staff. If billing is up to par and you’re diversified in your services and specialties, you can increase morale and solidify profitability. Maximizing reimbursement allows you and your staff to focus on providing top notch care, purchasing state-of-the-art equipment and creating a better overall experience for your patients.

The final piece to the puzzle is to align your ASC with other out-of-network providers.  Whether it’s an imaging center, physical therapy, durable medical equipment, or even a billing expert or healthcare attorney, a partnership with any can bring tremendous value. The challenge is to identify these providers and collectively maximize profit. I am continuously amazed when ASC leadership does not understand the value of networking with likeminded out-of-network experts and providers. Surround yourself with those who share your vast knowledge of the out-of-network universe.  

More Articles on Surgery Centers:
13 Statistics on Medicare Patient Volume in ASCs vs. Hospitals
20 Most Frequently Performed Medicare Surgical Services in ASCs
8 Keys to Keeping Surgery Centers a Profitable Business

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