Becker's ASC Review

24 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 lowering 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 4 mistakes to avoid with bundled payments, according to one administrator By Patsy Newitt B undled payments are a challenge for some ASCs — oftentimes, these payments mean the ASCs have to coordinate post-operative services and align a plan of care. Robert Lerma, the administrator of Blue Springs Surgery Center in Orange City, Fla., spoke with Becker's ASC Review on the challenges he sees in regard to bundled payments Note: This response was edited lightly for clarity Question: What are common mistakes ASCs make when handling bundled payments? Robert Lerma: Depending upon the negotiated managed care contract, the biggest problems with bundled payments are the following: 1. The inability in some bundled payment contracts to charge for supplies, disposables and sometimes implants. 2. ASCs negotiating the fees based upon the Local Total Payment as opposed to Local Medicare Payment. The rates are lower for the latter. Sometimes the higher rates are non- negotiable, but I always start with the highest rate possible and then negotiate to the center bottom line number for profitability. 3. ASCs not negotiating for a contract review date at least every two or three years. 4. ASCs not knowing or using the specific language for deductibles. n

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