Becker's Spine Review

23 How the payer & patient expereince landscape is changing for ASCs B everly Hills, Calif.-based 90210 Surgery Medical Center Administrator Benita Tapia discusses how the payer land- scape is changing and how her center improves the patient experience. She will be on a panel titled "e Peer Review Process for ASCs" at the Becker's ASC 25th Annual Meeting, Oct. 18-20 in Chicago. ere has been a tremendous change in the payer landscape and value-based care is defi- nitely the trend. Payers are making it difficult for ASCs to sustain out-of-network, and we are seeing max per day rates on OON cas- es some as low as $350 with some paid at a percentage of Medicare, which means larger deductibles and a larger coinsurance that the patient has to pay. is makes it not cost ef- fective for the patient or the ASC to do the case OON. We are seeing more and more bundled pay- ments and incentives for surgeons to bring eligible patients into the ASC environment, and payers are sometimes stating if the pa- tient is eligible, to go to the ASC for some procedures. e procedure may only be reim- bursed in the ASC and not the hospital en- vironment. I would predict that in the future we will see more incentives for the patient to go to an in-network facility, especially if the bundled payment meth- odology is chosen. ere would be less deductible and copayments for the facility and increased reimbursement for phy- sicians using the in-net- work facility and partic- ipating in the bundled payment methodology. Patients tell us over and over again they feel like they're given a more per- sonal experience. Hospi- tals are usually extreme- ly large and the patient has to encounter a multi- tude of different people. It can be overwhelming for patients navigating through a large hospital just to check-in for their procedure. In the ASC environment you oen find staff wearing many hats, you may find the pre-op nurse that took care of the patient will be there to greet the patient in the post-anesthesia care unit aer the case, which provides a continuity of care and a personal bond between the patient and the nurse. e long wait in hospitals of cases getting delayed and resched- uled because of emergencies can cause anxiety. e patient can be le NPO and anxious- ly waiting for their procedure and the operating room to become available. Usually cas- es go more true to time in an ASC environment. Anticipate the changing landscape of value-based care. Keep costs down, for example trying to have sur- geons use the same vendor for implants, etc. Volume allows for you to have in- creased buying power, so it's important to maintain and increase volume. Surgeons taking blocked time can help with staffing costs. n How a Virginia-based ASC combats consolidation and changing referral patterns A ndy Poole, CEO of Monticello Com- munity Surgery Center in Charlottes- ville, Va., discusses how his center is beginning to engage in value-based care. We are an independent ASC and we're in a market where there's consolidation among big healthcare systems. Primary care physi- cians are increasingly joining health systems and steering their cases to system-employed specialists, which makes it difficult for us to increase market share. As a result, we are en- gaging in more collaboration with neighbor- ing hospitals that see us as a great way to gain a presence in low-cost, high-quality centers. e group we work most closely with is an academic hospital [in Charlottesville, Va.], which is experiencing capacity issues. Since they are an academic center, they have an in- herently high cost structure. We are able to offer a lower cost of care for patients paying more out-of-pocket for elective procedures, or for their shared savings contracts. When the health system is ready, they can increase their outpatient market presence in a more competitive way aer working with us. at's a positive start, and for us it's about expand- ing services and growing physicians while maintaining relationships with the surgeons who already perform cases at our center. We are also working on direct contracting with large self-funded employers to set up our own value-based contracts with those groups so we won't have to rely as much on referrals from primary care physicians. is is still developing for us, but we are very excited about the potential here. We are one of the centers that truly believes and embraces transparent pricing. Many of our prices are online, available on our website. We also offer self-funded employers bundled surgical pricing through direct contracts. It's "I would predict that in the future we will see more incentives for the patient to go to an in-network facility, especially if the bundled payment methodology is chosen." — Benita Tapia, Administrator, Surgery Medical Center

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