Becker's ASC Review

34 Thought Leadership Employers, fed up with insurance companies, turn to ASCs By Laura Dyrda E mployers are increasingly interested in direct contracting with surgery centers through regional and national contracts, and ASCs are ready partners as high quality, low cost sites of care. "As the cost of healthcare benefits for employ- ees continues to rise, we are seeing continued requests for contracts that allow employers to provide high quality care services to their employees at a significant cost savings to the employer," said Mike Grant, administrator of Surgery Center of Amarillo (Texas). Direct-to-employer contracting can provide an additional revenue stream for physicians and surgery centers, especially if commercial payers are narrowing their networks and low- ering reimbursement rates. "ASCs that have an ability to bundle their services for specific procedures will have the opportunity to negotiate directly with self- insured employers, enabling their employees to get concierge-type services at reduced rates. By doing so, employers will reduce their loss time injuries and ensure that their employees receive high quality services in a controlled environment," said Christina Goodall, RN, DNP, administrator of Atlanta Orthopedic Institute. Nader Samii, CEO of National Medical Billing Services, and Alison Kuley, senior spine coder at the company, advised ASCs to enter into direct-to-employer contracts with specific companies to drive more spine surgeries to the facility in a September 2020 Becker's article. ey said ASCs could approach large employ- ers with a discount for employees in exchange for encouraging employees to select the center. "Given the significant cost of spine proce- dures, this will be very attractive to employers and will provide employees with a high-quali- ty destination for their surgeries," they wrote. National ASC chains are also engaging in direct-to-employer contracts. ValueHealth, which has a network of ASCs across the U.S., offers a program to employers, SurgerySav- ings, to provide surgery for employees. e company claims to provide more than $10,000 in savings per episode of care on high-value procedures. Dallas-based United Surgical Partners Inter- national executives are in the early stages of developing direct-to-employer, value-based contracts for its surgery centers. "It brings USPI centers and doctors' patients from distant geographies based upon employ- ers that are looking for high quality and high values," said Saum Sutaria, president and COO of Tenet, USPI's parent company, during the first-quarter earnings call April 21. e American Medical Association recom- mends physicians entering into direct-to-em- ployer contracts make sure contract language is clear that employers control the plan, but not the practice of medicine. e contract should also cover data-sharing and steward- ship, compensation, patient privacy and expected timing for progress reports." n How a Nebraska ASC manages prior authorization regulation, prevents revenue loss By Carly Behm A s prior authorization requirements grow in the outpa- tient space, ASC administrators have to find ways to balance finances at their centers. For one administrator, communication with physicians and payers has helped the center manage prior authorization rules. Brooke Day, administrator and business office manager of Hastings (Neb.) Surgical Center told Becker's ASC Review her center's strategies. Note: Response was edited for style. Question: How much do you estimate prior authoriza- tion to impact revenue at your center? Brooke Day: Prior authorizations can have a significant im- pact on our business. We implemented procedures a couple years ago that continue to be changed as unique situations occur. We are in constant communication with our physi- cian office schedulers regarding the authorization of their procedures, specifically orthopedics and gynecology cases. We are recommending physicians authorize specific code sets depending on the procedure due to the amount of work required to obtain payment after the procedure has been performed. Our scheduler is also verifying that these codes are on our contract with insurances and with specific insurances we are calling to verify the codes are a "covered benefit." We have found with specific codes that they are not always on the patient's specific medical plan so verifying coverage is an im- portant step in our process. We also verify that the scheduled codes are on the fee schedules for Medicare and Medicaid. If a specific code is not on their fee schedule the case is sched- uled in another facility where it will be covered or the patient is required to sign an advanced beneficiary notice prior to the procedure being performed. We have several procedures in place that can prevent a loss of revenue due to a lack of prior authorization but the cases that are more likely to have this occur are higher cost procedures and could result in a loss of thousands of dollars in supplies. We are fortunate enough to only have this occur in a rare cir- cumstance due to the processes we have implemented. n

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