Independent ASCs in the United States face daunting financial challenges as they seek to remain autonomous and resist being acquired by health systems or private equity-backed entities. Most independent ASCs are unable to leverage a corporate parent or rely on a scale-based negotiating position, thus preventing them from consummating competitive agreements with payers or vendors.
New York based consultant Gregg Gordon, a long-time healthcare executive who has led managed care relationships from both sides of the provider/payor paradigm, began working with independent ASCs a few years ago to help them negotiate improved payer agreements. What he found was a general apathy or indifference from many payers who he believes do not fully recognize the many value propositions that ASCs offer to them and their members.
“What I found wasn’t surprising; because each individual ASC is just one center, payers don’t have to pay much attention or do much to improve the deals in place,” Mr. Gordon said.”No single ASC by itself will have a meaningful seat at the payer table.”
It was this recognition that prompted the idea that independent ASCs would have a far better ability to advance their payer (and vendor) relationships by banding together to have one voice represent many interests.
In the summer of 2024, Mr. Gordon launched what he believes to be the nation’s first Independent Practice Association for ASCs called Surgical Solutions IPA. SSIPA is currently licensed in New York and will expand to New Jersey and Connecticut by the end of the year and expects to add new geographies beyond the NewYork tristate region thereafter.
SSIPA’s goals are to ensure that all stakeholders know and properly value the key performance indicators of ASCs that drive healthcare success:
- Reduced costs per case and per member relative to a hospital outpatient department
- Improved quality and lower incidences of facility-acquired infections
- Better outcomes than hospitals and lower incidences of post-operative complications that necessitate an ER visit
- A vastly better patient experience and importantly, a better physician experience too
Mr. Gordon recognizes that SSIPA cannot solely be a collective bargaining entity; value has to extend to the payers and third parties who are key stakeholders. SSIPA’s model enables payers to collect risk-scoring and quality-based data from its ASCs through a single relationship, and that helps payers to better understand their population health platforms and potentially generate higher risk-adjusted and/or quality-based premiums.
But in order to maximize the rate arbitrage between what payers pay to hospitals/health systems vs. ASCs for the same market basket of services, SSIPA is soliciting its payer partners to meaningfully embrace site-of-service decision-making tools at the point of authorizing surgical procedures.
Per Mr. Gordon, “If payers are able to empower their care coordination teams and consider benefit plan incentives that drive outpatient surgery volume to ASCs, nearly every stakeholder will win.”
In the age of consolidation and outsized leverage plays in the health care industry, SSIPA offers a meaningful alternative to ASCs in a way that enables them to maintain their independence and remain financially viable.
