Becker's ASC Review

32 Thought Leadership What reimbursement issues are costing ASCs the most? By Patsy Newitt F rom prior authorization to payer consoli- dation, ASCs have long faced obstacles in securing reimbursements. Seven ASC leaders spoke with Becker's ASC Review about the reimbursement issues costing their ASCs the most money. 1. Payer consolidation Jarett Landman. CEO of e Orthopedic Surgical Center of the North (Peabody, Mass.): e consolidation of payers has be- come an issue and should be a major concern. Economies of scale exist to create leverage. Exerting additional downward pressure on physicians and outpatient facilities already op- erating on thin margins will have a significant impact on the long-term viability of ASCs that operate independent of hospital affiliations. 2. Payer contract challenges Lori Martini, CASC. Administrator of SOG Surgery Center (Tupelo, Miss.): As a fairly new, independent ASC opened in 2019, negotiations with certain commercial payers have been a challenge. We are not yet in network with three major commercial payers, despite the substantial savings they would recognize by contracting with the ASC. We have had to provide explanations of benefits from hospital outpatient department cases in order to negotiate fair contract rates. 3. Implant costs Trina Cole. Administrator of Saint Luke's Surgicenter Lee's Summit (Mo.): One of the issues that affects our ASCs is implant coverage being nonexistent or too low with managed-care contracts. We utilize contract negotiations with our joint-venture hospital partner. Although a great asset, there are only a few ASCs in the health system. is can be injurious to our reimbursement at times. 4. Deductibles and copayments Glen Silverman. CEO of U.S. Orthopedic Partners and Mississippi Sports Medicine and Orthopaedic Center (Jackson): Without a doubt, our biggest challenge is handling deductibles and copayments. Both through value-based care arrangements and the continued industry-wide shi of risk to the consumer, our ASC continues to be burdened with significant out-of-pocket expenses. 5. CMS policy John Stewart. CEO and founder of Physi- cian Advisors and Total Spine & Wellness (Melbourne, Fla.): e same cutting-edge technology and care that patients receive and desperately need from our ASCs is the biggest reimbursement issue affecting revenue. Many of our procedures and surgeries have CPT codes that do not have a Medicare allowable in an outpatient ASC, so some third-party administrators and payers underpay or deny these surgeries. 6. Patient out-of-pocket costs Tracy Helme. Administrator at Seven Hills ASC (Las Vegas): Revenue issues that affect many ASCs revolve around the reduced amount of cash that patients have on hand at this time. ey are not always able to pay coinsurance and deductibles up front. is can pinch cash flows for ASCs. High deductible plans are also very confusing for patients, as they are not always aware of the high out-of-pocket amounts that are their responsibility before they receive benefits. 7. Prior authorization: Jason Richarson. CEO of Gastroenterology of the Rockies (Louisville, Colo.): For us, the big- gest reimbursement issue is procedure autho- rization issues. e administrative burden on authorization of services delays care, adds costs and adds no value to the patient experience. n Balancing rapid growth and patient care: Q&A with Stefanie Moertz By Patsy Newitt L os Angeles-based DOCS Surgical Hospital is investing in employee retention and medical equipment in response to the growth the ASC has experienced in the past year. Administrator Stefanie Moertz, RN, spoke with Becker's ASC Review about how DOCS Surgical Hospital is approaching the expansion while maintaining high-quality patient care. Question: What is the biggest challenge your center is currently facing, and how are you addressing that issue? Stefanie Moertz: DOCS Surgical Hospital's biggest challenge right now is keeping up with the rapid growth and expansion of our ASC and surgical hospital, while maintaining our culture of high-quality patient care partnered with cutting-edge technology. To address these growing pains we are investing in employee retention, satisfaction and training, in addition to acquiring the most advanced medical equipment available to increase patient safety and improve operating room efficiencies. n Restructuring an ASC post-COVID: Q&A with Christina Holloway By Patsy Newitt C hristina Holloway, administrator of the Ambulatory Surgery Center of Bala Cynwyd (Pa.) spoke with Becker's ASC Review on how her center is restruc- turing policies post-COVID-19. Question: What is the biggest challenge your center is currently facing, and how are you addressing that issue? Christina Holloway: Our center is currently in the process of reconstruction, which inherently creates staff- ing complications with established hours and requires flexibility in terms of facility needs versus job expecta- tions. Coming out of COVID-19 crisis, many people are appreciative of the additional tasks or roles needed for a company to thrive in times of difficulty. Utilizing this time to reformat needed policy/procedures, as well as review opportunities to improve new hire orientation, has allowed staff at all levels to become a part of a strategic plan that is difficult to devote time and attention to in times of high volume. n

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