4 Payor/Reimbursement Risk Factors That Impact an ASC’s Value

The third-party payor profile within a specific market and the ability to obtain favorable managed care contracts can impact an ASC’s value. Here are four managed care payor and reimbursement risk factors and the relative importance ASC operators place on them, according to VMG Health’s ValueDriver ASC Risk Assessment Survey.

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1. Concentration of patient volume/revenue from a single payor

  • Very low — 0 percent
  • Low — 0 percent
  • Medium — 23 percent
  • High — 50 percent
  • Very high — 27 percent

2. Level of reliance on out-of-network payors

  • Very low — 0 percent
  • Low — 0 percent
  • Medium —9 percent
  • High — 18 percent
  • Very high — 73 percent

3. Commercial reimbursement levels (as compared to Medicare)

  • Very low — 0 percent
  • Low — 0 percent
  • Medium — 55 percent
  • High — 27 percent
  • Very high — 18 percent

4. Contracting leverage with major payors in the market

  • Very low — 0 percent
  • Low — 5 percent
  • Medium — 36 percent
  • High — 50 percent
  • Very high — 9 percent


Information comes from VMG Health’s
ValueDriver ASC Risk Assessment Survey. VMG Health is a leading valuation and transaction advisory firm in healthcare. To receive a complimentary copy of VMG Health’s ValueDriver ASC Risk Assessment Survey, click here.

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