Becker's ASC Review

32 THOUGHT LEADERSHIP ASC-payer negotiations: 1 CEO's advice for securing the right contracts By Alan Condon N egotiating contracts with commercial payers is one of the most challenging and fatiguing aspects of an ASC administrator's role. But there are core strategies administrators should consider when sitting at the table with insurers, including arming oneself with cost and outcomes data, understanding the market and fostering good relationships with negotiators. Here are seven key considerations for ASC administrators negotiating with insurers, according to Alfonso del Granado, CEO and administrator of Covenant High Plains Surgery Center in Lubbock, Texas. 1. First and foremost, show value. is can take the form of demonstrating substantially lower than average complication, reoperation and hospital visit rates — meaning a lower overall cost per episode of care. It can also be an incentive if you are considering starting a procedure or service line to bring actual volume numbers for procedures you will be shiing from a local HOPD to your ASC, and if one or more of the affected surgeons can furnish you with their patients' explanation of benefits, you will have a sense of the scope of the potential savings the payer can accrue. 2. Another consideration has to be that the person you are negotiating with may only be interested in controlling costs for their ASC unit and will not be moved by the possibility of lowering HOPD and global costs — they may even be counterincentive depending on their bonus structure. If you are getting a surprising lack of interest, make every effort to move up the ladder until you find the person who is motivated to lower costs for the whole region. 3. A corollary to this approach may be to bring up how much it will cost you to implement this new procedure or service line. Be sure to include all costs associated with this project, including obviously direct case costs such as equipment, instrumentation, supplies and labor, but be sure to add indirect costs such as OR minutes (which should encompass general overhead) as well as opportunity costs (what you could be earning if you spend the resources on starting How orthopedics, spine surgery will evolve at ASCs in the next 2 years, per 1 administrator By Ariana Portalatin E xpansion of procedures, new technology and physicians taking back autonomy are three ways one ASC administrator sees orthopedic and spine surgery changing in the next two years. Greg Deconciliis is a physician assistant and administrator at Waltham, Mass.-based Boston Out-Patient Surgical Suites. He discussed work at the center and the trends he is following in orthopedic and spine surgery. Question: What are some trends that you are following most closely today? Greg Deconciliis: When I think about trends, my mind jumps right to orthopedics and certainly the shift that we've seen in terms of types of cases. We've been performing total joint replacements and some spine procedures, more minor procedures now for quite some time, about five years, but we still don't have a really strong, robust program because we have a small three-OR facility ... but we're following this shift and we're making some movements for the future to position ourselves to be able to provide some more of these total joint replacement, spine procedures and some obviously larger acuity orthopedic cases. Q: How do you see orthopedics, spine and ASCs evolving in the next two years? GD: This trend of growth, I think, will continue. We're kind of last to do things, so for us primaries are kind of a big deal around here, but certainly I think scaling the types of arthroplasty — so maybe revision arthroplasty, some larger spine procedures, those types of things, maybe even scaling into patients who have higher BMIs or more comorbidities — scaling the types of patients we're doing as well as we get more comfortable. Those are certainly big things. The advances in anesthesia and technology ... We certainly see them kind of shaping our future and they've obviously shaped the ability for us to do orthopedics even early on back in 2004, but they'll continue to shape that as we go forward as well. There will be a big focus on technologies and not only things like robots, but technologies that we utilize to make us more efficient, more precise, provide better patient care, all those types of things. There's just so much growth in technology, you have to keep up with it. 3D printing [and artificial intelligence], there's a lot out there. What we're also seeing in our area, recently some consolidation in some joint ventures and partnerships with hospitals and private equity growth. I think we'll see maybe a little more independence with surgeons and realizing that there's a big jump in the employed model, and maybe there's some frustrations there. They certainly are in our area. Physicians coming together to take back patient care and how their lives run and what they can do with their patients I think is really key, so we'll follow that over the next couple years and kind of see how things shape out. It's obviously very exciting. n

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