Five insights:
1. Deerfield, Ill.-based Surgical Care Affiliates has joint-venture partnerships with 215 ASCs, and about 60 percent of those have at least one value-based contract in place. SCA is currently focused on negotiating value-based contracts with insurance companies and Medicare, rather than large companies that self-fund their medical claims.
2. Each highly customized contract tops out at five years, maximum. Payers get back a portion of reimbursement if the ASCs don’t meet cost and quality targets.
3. To maximize revenue on each case, SCA calculates the expected reimbursement and thoroughly evaluates the risk.
“Our revenue recognition process is complex to begin with, from [the financial planning and analysis] standpoint — we have to forecast what the procedures are going to be, who the payers will be and what bad debt there could be,” Ms. Zulla said.
4. About 20 percent of SCA’s net revenue comes from patients, who are assuming greater financial responsibility for their care.
5. SCA is part of UnitedHealth Group’s health services business, Optum, which accounts for about one-third of UnitedHealth’s revenue. However, UnitedHealthcare isn’t always SCA’s go-to insurer; SCA seeks the best risk-adjusted rates in each market.
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At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.