Brent Ashby, administrator of Audubon Surgery Center, Audubon ASC at St. Francis and Women’s Surgical Center, all located in Colorado Springs, Colo., says that his biggest concern, and unknown, for next year is the impact of “Obama Care” on ASCs. “Nothing has really been said about how ASCs would fit in this new paradigm, and it appears that some sort of health reform will pass the Congress,” he says.
Sandy Berreth, RN, MS, CASC, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., agrees that the “overwhelming complexity of healthcare reform” is a big concern for ASCs. Ms. Berreth hopes that healthcare reform efforts will successfully expand healthcare coverage while providing adequate reimbursements to healthcare providers, such as ASCs. “The government wants to fix the current state of the healthcare economy. Unfortunately, as with everything, the rules, regulations and requirements often make this more a cumbersome process than a helpful, genuine process,” says Ms. Berreth.
Uncertainty about the impact of healthcare reform on the ASC industry can be unsettling, and as a result, Ms. Berreth hopes that industry groups fight for the future success of ASCs. “The future is not necessarily in the hands of the average ASC but in the industry’s hand, with lobbyists and consultant groups,” she says.
Eroding reimbursements, rising costs
Another concern for 2010 involves declining reimbursements and increasing costs.
According to Nancy Burden, administrator of Trinity Surgery Center in Tampa Bay, Fla., and director of ambulatory surgery for BayCare Health System, rising costs and falling reimbursements are the biggest concerns for her ASC. “There are many concerns out there for all ASCS, but for us, the key concern continues to be the erosion of reimbursement coupled with rising costs for staffing and supplies,” she says.
Ms. Burden reports that her ASC is responding by seeking out carve-outs in payor contracts for high-cost procedures and implants and renegotiating vendor contracts. She also suggests that ASCs reduce staffing hours wherever possible, but warns that this may be a double-edged sword threatening the ASC’s relationship with its employees. “You don’t want to lose good people,” she says.
Relationships with commercial payors
Contract negotiations have always been a challenge for ASCs, and ASC leaders expect this to be no different in the new year.
Ms. Berreth says that contract negotiations with insurers are part of a “broken system” where insurers set fee schedules and ASCs either agree to the payment rates or choose to go out-of-network. As a result, ASCs charge what insurers are willing to pay, regardless of how that payment reflects costs to the ASC, says Ms. Berreth. Some ASCs then accept rates that do not fully reimburse costs on some procedures while recouping these losses on other procedure rates.
Additionally, administrators report increased pressure from commercial payors to go in network. ASCs that choose not to go in-network may be the target of “veiled threats about the complications of a non-participating status,” says. Ms. Berreth.
Commercial payors’ reimbursement methodology
Another potential concern is the reluctance of commercial payers to abandon the grouper payment methodology. With Medicare having migrated to APCs and a new rate schedule for ASCs. it is likely that by 2011 many ASCs will be paid less than Medicare by commercial payers for a variety of procedures, says Mr. Ashby.
“The problem escalates each year because the base rate schedule used by the payers is the old Medicare fee schedule that has not been adjusted since 2001. As such, even if you have a contract based on groupers that pays 150 percent of Medicare, you may be getting paid less than Medicare pays now,” he says.
Mr. Ashby reports that the ASCs he works with plan to address this issue in 2010, after the new Medicare rates are released. “If we can’t persuade the payers that the current system will not work for us then we will likely be going out of network,” he says.
What are your top concerns for 2010? Send your thoughts to becker@beckersasc.com.
