Becker's ASC Review

14 ASC MANAGEMENT The benefit and burden of value-based care for surgeons, ASCs By Laura Dyrda T here is a renewed push for value-based care as the number of COVID-19 cases ticks down nationally and federal funding to support healthcare organiza- tions wanes. Insurers and health systems are working together to devel- op value-based contracts where providers take on more risk for outcomes with the goal of eliminating wasteful spend- ing. Health tech companies have also become part of the equation, developing systems to gather data, automate processes and enable virtual care. Value-based care seems like a winning proposition for a healthcare system where spending is already high and pa- tients who need lower out-of-pocket costs. But what about surgeons and ASCs? If surgeons could simply practice medicine and do what's best for patients, it would be an easy sell. However, that's not the case. Value-based care requires much more data- gathering and reporting than fee-for-service contracts, in- creasing the administrative burden on physicians. "The devaluing of the physician with extensive clinical ex- perience and wisdom because of increasing administrative burden to treat our patients, thereby causing early burnout, is the biggest danger to our profession today," said James Bradley, MD, an orthopedic surgeon at the University of Pittsburgh Medical Center. With a physician shortage looming, the healthcare system can't afford to lose many more. Private practice and ASC ownership can reinvigorate surgeons and add value to the healthcare system, since surgery centers are often high quality, low cost settings for care. "Medicine is becoming increasingly sensitive to value, and there is no question that when redesign of practices comes about to reduce cost, the least value-added portion of healthcare is administration," said Robert Szabo, MD, an orthopedic surgeon at University of California-Davis Health. "Private practice cuts out the multiple levels of administra- tion that exist in big healthcare systems." It makes sense for insurers to value ASCs highly, but many surgery centers are still forced to operate on razor-thin mar- gins because rate increases aren't keeping pace with infla- tion. Surgery centers, as small businesses, often don't have access to the same data-gathering and reporting capabili- ties. The challenge next for insurers will be finding ways to support independent healthcare providers through the val- ue-based transition in ways that won't add more administra- tive burden to the average patient interaction. n Why insurers, health systems are breaking up By Laura Dyrda I nsurers and health systems across the U.S. have been at odds during the most recent cycle of contract negotiations, and terminated contracts are affecting thousands of patients. As hospitals continue to recover financially from the CO- VID-19 pandemic and deal with higher supply costs and employee wages, many organizations have tightening margins and hope to negotiate higher rates with insurers as a result. Hospitals are also pointing to rising inflation as a reason for needing higher rates. One recent example is Fort Lauderdale, Fla.-based Bro- ward Health's public breakup with UnitedHealthcare. Thou- sands of the insurer's beneficiaries went out of network with Broward April 1 after the two sides failed to agree on a new contract. Broward reportedly asked UnitedHealthcare for a pay increase to the same level UnitedHealthcare pays other South Florida health systems. UnitedHealthcare said Broward's rate increase request would amount to 88 percent higher reimbursement for its providers in the next four years, which the insurer said was "unreasonable." Negotiations continue, but patients are out of network in the meantime. Blue Cross & Blue Shield of Mississippi and the University of Mississippi Medical Center let their contract expire April 1 after they failed to agree on pay rate increases, accord- ing to the Clarion Ledger. The medical center treated more than 50,000 patients in the 18 months before the contract expiration. LouAnn Woodward, MD, vice chancellor for health affairs and dean of the medical center's school of medicine, said the health system wants "fair reimbursement" from Blue Cross & Blue Shield to reinvest in its facilities and programs. The insurer said the medical center wanted a 30 percent overall rate increase, including a 50 percent increase for some services, according to the newspaper report. Physician groups and surgery centers aren't immune from insurer conflicts. Blue Cross Blue Shield of Illinois termi- nated its contract with Springfield (Ill.) Clinic late last year, knocking 100,000 beneficiaries out of network. n

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