Issue link: https://beckershealthcare.uberflip.com/i/1172132
Executive Briefing: 40 Executive Briefing rates as a base low rate of reimbursement and then reach out to commercial payers. What is the reimbursement for the service in your market from Medicare and commercial payers? Can you still offer that service if it is considered "new" on an out-of-network basis and get reimbursed? You must consider physical requirements for providing the new service, as they sometimes dictate more expenditure. You must know if any new equipment, electrical or mechanical issues are required. If so, investigate how vendors may be able to assist you in helping establish the new service. Is there a vendor partner who can provide equipment at no fee for a short time, supplies at a promotional cost or free pricing for initial months? Pricing strategy is key, and this is a function of how much money is needed to bring the new service on line, and then sustain it. Begin your financial projections with legal, accounting, equipment and other capital start-up costs. Will you need any renovation for the building and additional staffing? What will be the supply/drug/implant costs? A return on investment needs to be assessed. Calculate revenue by procedure to project the expected net revenue for the new service line. Make a best estimate of the number and type of procedures for the year, calculating the net revenue (collected dollars per procedure) based on best estimates of reimbursement (research your area). Costs for salary, supplies, drugs, implants, rent, accounting, legal and other normal operating expenses get subtracted to determine the best estimate of a cash profit for that service. Next, calculate the estimated reimbursement for procedures versus the expected discounts from area payers. For example, if the typical discount from payers is 80-85% of charges in the area, based on the projected reimbursement, a mark-up on the projected net revenue must be calculated to project a proper return on investment. This provides an estimate of the profit needed to meet the return on investment target. Final stages of planning include several factors. Establish clinical protocols using best practices from what your physicians and nurses have researched from other ASCs that have successfully added the service. It is the responsibility of your nurse administrator to assure all supplies, drugs, implants and all other clinical items are ready. Set up a good revenue cycle, proper coding and insurance verification for the new service to assure proper payment. A dry run with the staff is a good idea to assure smooth patient service once the program is implemented. Finally, your ASC governing board should set criteria for clinical, patient and physician satisfaction, and financial measures for the success of the new service. This will help to objectively determine if the service is successfully meeting your ASC's goals, and provide criteria for feedback and improvement for the continued success of the service line. Adding a new service line is a team effort among all the stakeholders of the ASC. It should be an exciting time for growth of your ASC. With strong physician and staff support, as well as proper operational planning and objective financial planning, the service line has the best chance of being successfully implemented. n Robert Zasa is president and founder of Ambulatory Systems Development. Contact: RZasa@asd-asc.com or 626-840-4248. One of the nation's most legendary and innovative ASC companies, with a history of success in over 200 surgery centers in 30 years. The firm's offerings are threefold: 1) An ASC revenue development company that plans and implements the addition of new medical services to seize opportunities in the expanding ASC industry to grow a center's revenue streams. 2) An ASC management company with a transformational approach to re-engineering business and clinical operations to optimize performance, financial margins and patient outcomes. 3) An ASC investment partner with a history of balancing the ownership model to maximize market capture, offering capital as a minority partner. The firm operates under the direction of Robert Zasa, MSHHA, FACMPE, president and founder. AmbulatorySystemsDev.com