The cost of implants — and getting reimbursed for them — continues to be imposing for orthopedic and multi-specialty ASCs (see “Reimbursement, Profit and Patient Selection Issues — Spine and Orthopedic Cases” on pg. 1 for more). Here, in an interview with Bill Cramer, CEO of Access MediQuip, and Brent Ashby, administrator and CEO of Audubon Surgery Center in Colorado Springs, Colo., we discuss one solution to that problem.
Stephanie Wasek: Describe the implantable device segment of today’s healthcare market.
Bill Cramer: It’s a segment that’s experiencing double-digit growth. With industry research showing that implantable medical devices are achieving positive patient outcomes, physicians and facilities are increasingly using them to treat patients. New implantable devices are rapidly coming to market, and many
procedures are able to be done in outpatient settings. Payors are finding it challenging to keep pace with spending on these devices. As a result, the pressure and scrutiny for ASCs getting reimbursed for these devices is greater than ever.
Brent Ashby: I agree; at our facility, our implant expenditures have increased dramatically over the past few years. In 2002, implant expense comprised approximately 5 percent of our net revenue. By 2007, that number had increased to nearly 15 percent.
SW: Can you describe the challenges a facility experiences when conducting procedures involving implants?
BC: Healthcare facilities are being squeezed on multiple fronts: increased pressure from physicians and patients to purchase costly implantable devices, while maintaining profit expectations to survive in today’s economy. Because implantable devices are a small, but rapidly growing, healthcare segment, it’s difficult at best for facilities and group purchasing organizations to leverage buying power or enforce compliance. The end result is that unpredictable costs and the risk of not being reimbursed for implantable devices are putting a severe strain on facilities’ cash flow and profitability.
BA: I’ve seen some payors refusing to pay for implants. This has already been a problem for many years with Medicare and other government programs, but other payors are beginning to follow suit and are unwilling to incorporate payment for implants into their contracts.
SW: As a leader in providing implantable device acquisition services, how is Access MediQuip addressing these challenges?
BC: When we founded Access MediQuip more than a decade ago, the idea behind our model was to free healthcare facilities and physicians from the burden and risk of purchasing, billing and collecting for implantable devices. We have successfully achieved this by creating a model in which we purchase implantable medical devices directly from the manufacturers and obtain reimbursement for them. Because this is our sole specialty and focus, we have developed an extensive manufacturer/product portfolio to meet facilities’ and physicians’ needs. We also work with more than 1,200 payors, so we maintain solid relationships with the payor community. The result has been improved and more affordable healthcare for patients.
SW: What are the key benefits for healthcare facilities to work with you?
BC: The three key results we see facilities achieve are fiscal predictability for implantable device procedures, increased cash flow and profitability, and reduced financial risk and capital requirements. In certain situations, we’ve helped facilities increase case volumes by removing the high-cost obstacle from implantable device procedures.
Stephanie Wasek: Describe the implantable device segment of today’s healthcare market.
Bill Cramer: It’s a segment that’s experiencing double-digit growth. With industry research showing that implantable medical devices are achieving positive patient outcomes, physicians and facilities are increasingly using them to treat patients. New implantable devices are rapidly coming to market, and many
procedures are able to be done in outpatient settings. Payors are finding it challenging to keep pace with spending on these devices. As a result, the pressure and scrutiny for ASCs getting reimbursed for these devices is greater than ever.
Brent Ashby: I agree; at our facility, our implant expenditures have increased dramatically over the past few years. In 2002, implant expense comprised approximately 5 percent of our net revenue. By 2007, that number had increased to nearly 15 percent.
SW: Can you describe the challenges a facility experiences when conducting procedures involving implants?
BC: Healthcare facilities are being squeezed on multiple fronts: increased pressure from physicians and patients to purchase costly implantable devices, while maintaining profit expectations to survive in today’s economy. Because implantable devices are a small, but rapidly growing, healthcare segment, it’s difficult at best for facilities and group purchasing organizations to leverage buying power or enforce compliance. The end result is that unpredictable costs and the risk of not being reimbursed for implantable devices are putting a severe strain on facilities’ cash flow and profitability.
BA: I’ve seen some payors refusing to pay for implants. This has already been a problem for many years with Medicare and other government programs, but other payors are beginning to follow suit and are unwilling to incorporate payment for implants into their contracts.
SW: As a leader in providing implantable device acquisition services, how is Access MediQuip addressing these challenges?
BC: When we founded Access MediQuip more than a decade ago, the idea behind our model was to free healthcare facilities and physicians from the burden and risk of purchasing, billing and collecting for implantable devices. We have successfully achieved this by creating a model in which we purchase implantable medical devices directly from the manufacturers and obtain reimbursement for them. Because this is our sole specialty and focus, we have developed an extensive manufacturer/product portfolio to meet facilities’ and physicians’ needs. We also work with more than 1,200 payors, so we maintain solid relationships with the payor community. The result has been improved and more affordable healthcare for patients.
SW: What are the key benefits for healthcare facilities to work with you?
BC: The three key results we see facilities achieve are fiscal predictability for implantable device procedures, increased cash flow and profitability, and reduced financial risk and capital requirements. In certain situations, we’ve helped facilities increase case volumes by removing the high-cost obstacle from implantable device procedures.