Boosting pay at eye centers: Q&A with Bergen-Passaic Cataract Surgery Center's Caroline Ivanovski-Hauser

Improving reimbursement may seem like an uphill climb in the current healthcare climate. However, there are steps that ambulatory surgery centers can take to offset the roadblocks.

Caroline Ivanovski-Hauser, administrator at Bergen-Passaic Cataract Surgery and Laser CenteC Ivanovski-Hauser photor in Fair Lawn, N.J., discusses some of the strategies implemented at her center to improve reimbursement.

Question: What are some of the most effective strategies to improving reimbursement at eye centers?

Caroline Ivanovski-Hauser: Effective strategies to improve reimbursement in an ophthalmic ASC ultimately have one common goal — to function at the highest level of efficiency while controlling costs.

Review the center's schedule and focus on gaps and underutilized block time.   Condensing the schedule eliminates excessive overhead and is a big cost-saver. In addition, the condensed schedule will allow other surgeons access to the center thereby increasing volume and reducing overall cost-per-case. Procure new technology, which will attract surgeons and patients, and as it is often not eligible for insurance coverage, can provide an additional revenue stream for the center.

Good billing practices are more important than ever as payers shift an increasing amount of responsibility to the patient. All patient insurance information should be verified by the center prior to surgery as collection of deductible, coinsurance, and/or copays done prior to surgery more than offsets the time and cost of obtaining that information. Chasing after patient money is always far less cost-effective than receiving it up front.

Insurance contracts should be updated and renewed to include carve outs for high-cost procedures, supplies and implants as well as provisions for new technology.

Q: What are some of the most common hurdles standing in the way of financial profitability at eye centers?
CIH: The most common hurdles impacting financial profitability at eye centers are low reimbursement rates and high supply costs. Ophthalmic ASCs perform most procedures on Medicare age patients and are therefore reimbursed as per the Medicare Fee Schedule. Commercial payers are able to take advantage of the homogeny of the patient population and use the MFS schedule as a basis for contract rates. Ophthalmic ASCs do not have the flexibility of multispecialty centers and therefore need to focus on efficiency.

The cost of supplies has risen significantly over the past year, while overall the ophthalmic ASC rates increased slightly. In order to combat these rising costs appoint staff members to compare products and prices on an ongoing basis and negotiate volume discounts to help offset the increases. However, beware that the volume discount does not leave the center with enough widgets for 10,000 cases when it only performs 2,000 a year.

Q: What are some common mistakes eye centers make that decreases reimbursement?

CIH: The biggest mistake a center can make is not knowing what procedures cost. Performing cases, which have negative reimbursement on a continual basis impacts the profitability of the center. All of the elements of a case, including overhead costs, must be included and analyzed to provide the center a clear financial picture. Additionally, not reviewing which procedures are done; how often; and by whom leaves a center at a distinct disadvantage in terms of negotiating, staffing and scheduling.

In an ophthalmic ASC this mistake is most evident with cases that involve implants, including IOLs, and new technology cases.
Q: Do you think reimbursement at eye centers will trend up or down in the next five to 10 years?

CIH: I am hopeful that they will trend up. I support all of the efforts being made by various organizations on behalf of ophthalmic ASCs and feel that eventually the great patient satisfaction rates and cost efficiency of ASCs will provide the key to opening peoples' eyes.

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