Becker's ASC Review

26 THOUGHT LEADERSHIP Payers' missed opportunity in ASCs By Ariana Portalatin P ayers should adjust reimbursements for more cardiology procedures to align with the quality and cost advantages of these services in the ASC setting, one ASC leader says. Tiffany Zachary is the administrator of Manhattan (Kan.) Specialists Center. She recently spoke with Becker's about the changes she wants to see from payers in 2024: Editor's note: is response was lightly edited for clarity and length. Question: What changes do you hope to see from payers in 2024? Tiffany Zachary: I would expect payers to recognize both the quality and the cost advantages of shiing some of the lower risk procedures to the ambulatory surgery setting. Recently, Medicare approved the placement of the CardioMEMS pulmonary pressure monitoring system in the ASC setting. is is a testament to the shi of more and more cardiovascular procedures confined to the hospital setting, until now. I would expect the commercial payers to follow this lead. Given the highly successful demonstration of performance of cardiovascular procedures in this setting, I would expect the reimbursements to improve in the ambulatory setting for most cardiovascular procedures, to encourage both payers and patients to look at this option. With the patient getting more aware of price transparency, this may become inevitable for some of the procedures. One classic example is pacemaker/implantable cardioverter defibrillator generator changes, which are now oen performed in hospitals at a much higher cost. ough they are also done at ASCs, the awareness of this option seems to be lacking. n Independent physicians have been 'left without a voice': Viewpoint By Patsy Newitt Physicians are continuing to migrate to employed models as practice costs rise. Thomas Schuler, MD, spine surgeon and founder of Reston-based Virginia Spine Institute, joined Becker's to discuss why independent physicians don't have more power in healthcare. Editor's note: This response was edited lightly for clarity and length. Dr. Thomas Schuler: Private practice physicians focus on their patients and work responsibilities, not political action. Work demands stretch these physicians thin. Unfortunately, they do not focus on the large scale political picture since they are consumed by the daily obligations to patient care. This results in the private practice doctor's perspective and interest not being represented on the political stage. Furthermore, hospitals and insurance companies spend much money on lobbying to achieve their control and ultimate financial success. Organized medicine does not represent the private practice physicians adequately. The individual physicians are left without a voice and without power in healthcare. n 'A very leveraged gamble': Spine surgeons' payer negotiation strategies By Carly Behm Negotiations can be a tricky balance for spine surgeons who want to get the most from payers. Two spine surgeons discuss their approaches to payers in 2024. Editor's note: Responses were lightly edited for clarity and length. Question: What strategies are you using for payer negotiations in 2024? Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: For the most part, dealing with payers remains a very leveraged gamble. We are doing the best we can to avoid dealing with payers by doing more direct patient care. Payers are still trying little maneuvers like recouping for cases done three years ago that they already underpaid. I am not sure you can negotiate with a crocodile. Payers have little to no pressure to behave, nor play by their own rules. Many patients cannot afford direct pay, but it does offer a way forward. My hope is at some point, HHS and the FTC will do the right thing and enforce existing laws on these payers, and take away their antitrust exemptions so that they can be regulated like every other company. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Eliminate any confusion when seeking approvals in procedures and coding. If appeals are necessary, then careful discussion and modality-based substantiation is utilized. Attempts at delayed post-operative denials is the new mantra, and this is accomplished with rapid resubmissions and clarifications if needed. n

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