Becker's ASC Review

35 CODING & BILLING Casetabs & Surgical Notes to integrate transcription, document management software By Rachel Popa R evenue cycle service provider Surgical Notes has partnered with surgery coordination app Case- tabs to integrate the companies' ScanChart ASC and SNChart software. The integration of the two platforms eliminates the need to manually fax, label and scan patient docu- ments when a physician's office sends them to an ASC. The platforms help ASCs improve revenue cycle processes by showing where documents are missing signatures and other key information. "We know that many of our users also rely on solutions from Surgical Notes to deliver high quality, cost-effi- cient care. The integration of our products will help our clients better achieve these and many other clinical, fi- nancial and operational objectives," said Gavin Fabian, Casetabs founder and CEO. n The key financial concepts and payer trends for ASCs today By Laura Dyrda T homas K. Miller, MD, is the sports medicine chief at Caril- ion Clinic Institute for Orthopaedic and Neurosciences in Roanoke, Va. He has experience with outpatient surgery and spent time as a team physician for the USA Triathlon team. Here, he discusses the big challenges and opportunities for orthopedic centers today. Question: What is the biggest challenge for your ortho- pedic center today? Dr. omas K. Miller: e biggest challenge is recognition that accurate case costing and determination of a positive fiscal margin is a much more fluid target than in the past. We have experienced a number of implants suppliers move to implant cost mark ups, oen unannounced or unanticipated. Increases in the 4 percent to 4.5 per- cent range for implants and technology that we have used for years are not uncommon. At the same time, we find ourselves in contract discussions with commercial insurers that are far more restrictive in their consideration of facility reimbursement increases than prior negotiations. We cannot assume that a given case is profitable simply because 'it always has been.' Q: Where do you hope to grow for the next nine months? TM: As CMS continues to direct cases from the hospital-based en- vironment, including hospital-associated ambulatory sites, we need to make sure we continually assess OR-utilization and offer new, and current, providers access for these cases either through reliable open time access or reassignment of block times. As healthcare expenses continue to rise, ASCs need to make sure they actively court and are prepared to absorb the migration of cases from hospitals to free- standing sites of service. Q: How do you approach budgeting for and selecting new technology for your center? TM: ere are three core questions: 1) Is the new technology bottom line fiscally positive? Case-costing can be a challenge especially if commercial insurers are skeptical of a procedure and inclined to deny payment. New technology may oen be associated with ancillary case costs not typically considered. While some short-term loss may be acceptable during phase in, ul- timately even the most intriguing or innovative surgical offering still needs to generate a positive income stream. 2) Does the new technology fit into or expand our existing service line and case mix or will it require a significant change in case scheduling, block times/OR access for current providers, staff train- ing, facility work flows and patient throughput? We do not want to compromise our current positive case mix but we also want to retain facility users as they embrace new techniques and recruit new users if they bring the right case profile, including new technology and techniques. 3) Will the new technology realistically bring new cases, and are the anticipated volumes sufficient to justify the expense in new equip- ment and support services? Q: What are your biggest payer challenges today? TM: As CMS has encouraged case migration to freestanding ASC sites via fiscal incentives, we have not seen commercial insurers fol- low this ASC-centric shiing of payment increases during current contract negotiations. In addition, while CMS seems to be embracing techniques or technology that improves patient care via line item medication or implant reimbursement to cover costs in freestand- ing ASCs, we find the commercials unwilling to follow their lead ultimately either requiring wholesale renegotiation of contracts to bring one or two implants, procedures or medications on board. is either forces the center to consider stepping away from otherwise suitable contracts in place, choosing to not offer a service or inter- vention or absorb not insignificant costs to provide state-of-the-art care that even governmental agencies want out of the more expensive hospital-based care setting. n

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