What it takes to beat declining reimbursements and higher costs: Key thoughts from the executive director of 3 ASCs

Catherine Ruppe, RN, CASC, executive director of Issaquah, Wash.-based Proliance Highlands Surgery Center, Bellevue, Wash.-based Overlake Surgery Center and Redmond (Wash.) Surgery Center, discusses how she sees the payer landscape changing and what is in store for her ASCs in the future.

Ms. Ruppe will speak at the Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs, October 18-20, 2018 in Chicago. Click here to learn more and register.

Q: How have you seen the payer landscape change over the past three to five years?

Catherine Ruppe: Declining reimbursement and higher costs. You have to be much more cost-conscious today when you are scheduling cases than you did in the past. Some of the orthopedic procedures used to have multiple codes involved, such as ACL surgeries, and now they are bundled to just one code, which hurts the reimbursement rate.

We have also noticed that for some of the big payers, there is more preparation work to do and paperwork to fill out to show the conservative treatment has been done. Our mountain of paperwork grows every day and adds cost to the case because our staff is taking another 10 to 15 minutes than usual to schedule the case. That time all adds up.

Q: What are you doing now to prepare for the future?

CR: At two of my ASCs, we are really looking for a single source to commit to all implants from one vendor. We are looking to achieve the best price for quality implants. At these two centers, we have a significant volume so choosing one vendor is a win-win for us. That is the biggest focus for us and the most challenging; it took a physician champion to really promote our future savings. The surgeons see the numbers I put forth, but I'm not the one using the implant, so they have to buy in and know they're using a quality device to achieve a great patient outcome. Surgeons want to know they will still be able to achieve the best outcomes for their patients.

Q: What is the smartest thing your ASC does to improve the patient experience, beyond the typical advantages an ASC has over time?

CR: I have three centers and we triangulate a precise metropolitan area, so we are able to offer lots of free parking. We've also taken the high-end approach for design and build. We are space-efficient, so the workflow makes sense for staff and our centers have lots of storage room. We want to make the ASC friendly and comfortable for the patient. At the most recent center I'm opening, we included high-end flooring to ensure the patient has a calming and soothing experience. We have received comments on our nice art work, comfortable furnishings and feel; our ASCs don't feel clinical. Patients also comment on how warm and welcoming the centers are because they feel more like a spa than a hospital, but we also have the latest technology. Every patient room is private and has a TV, and patients have control of their stretchers so they can raise their own head.

We also talk a lot about customer service and moving patients discharged safely. Sometimes we have to balance that with patients saying they aren't ready to go home. We talk about our patient surveys every quarter and go over the responses.

Q: Over the next two to three years, what is the biggest opportunity for ensuring profitability at your ASC?

CR: We are really working on migration of outpatient joint and spine from the inpatient arena. We are looking at having our own bundles as well. A clinical outcomes nurse is looking at cases done at the hospital and figuring out why the surgeons performed them at the hospital and whether those cases could be done in an ASC.

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