Becker's ASC Review

40 Jeff Blankinship Coding, Billing & Collections 4. Patients will become the ASC's primary customers. Surgery center administrators and managers have traditionally considered the surgeons or referring physicians their primary customers because they drove cases to the center; however, when patients, in conjunction with their employers' benefit plan designs, become primary decision-makers about their care, they will become the customer. "Patient loyalty has never been a strong point for ASCs because there isn't a strong relationship between the patient and the facility," says Mr. Blankinship. "ASCs need to start acting like other business verticals and expect that if someone has surgery, it's pretty likely that someone in their family might have another surgery in the future." Bud Brooks Providing the best patient experience possible and directing marketing efforts toward patients will increase the opportunity for repeat visits and positive word-of-mouth promotion. 5. More employers are self-funding insurance. As employee satisfaction with insurance plans diminishes, more companies have developed self-funded healthcare plans. These companies are looking for partnerships with high-quality, low-cost options for care, and some of the bigger corporations will even send patients thousands of miles to seek cheaper healthcare options. Dr. Keith Smith "Companies are thinking the managed care contract," says Mr. Brooks. "Employers are either doing away with PPOs entirely because they are relatively meaningless or they are putting the PPOs on a second tier of benefit design, with a specialty carve-out network occupying the first tier – tied together with drastically richer benefit incentives for the employees. Every network says their discounts are best, when in fact they are just arbitrary savings below an arbitrary price. People really want to know what things cost." When employers have control of the healthcare dollars, they do their research and direct employees to low-cost providers. Make employers in your area aware of your price structure so they can take advantage of the lower cost. Many Americans don't realize their healthcare policies have limitations on insurance payment; they think as long as they've met their deductible, everything else will be covered. "They aren't aware of the threshold and that they will be responsible for more," says Mr. Blankinship. "With price transparency, insurance companies will have to be more transparent with their own agreements and policies. This will help the general public become more aware of the options they have and choose where they want to receive their care." "In the group health self-funded world, employers are going to be the ones who will access the ASCs and utilize the transparent pricing," says Mr. Brooks. "This would also apply to workers compensation, but Texas is the only state that currently allows employers to opt out of the state-mandated program for self-funded workers' comp instead. There are many large employers in Texas that have become non-subscribers for their workers' comp." Around 60 percent of all employers are selffunded as of 2013 and they have more flexibility to direct employees and their families for care. "There has always been an imbalance in cost between the hospital and ASC for surgical proce- dures, which has become even more important for self-funders because they are not depending on the PPO networks and locked-down network rates," says Mr. Blankinship. 6. People want control over their healthcare spending. One of the biggest reasons for personal bankruptcy is healthcare-related expenses; people don't realize they have a huge medical bill until after services are rendered, and they can't make their payments. "You hear different stories about someone having a little repair and then getting billed charges that are inflated," says Mr. Blankinship. "Healthcare is the only place where you have the service performed before you know ballpark costs of what the bill will be. Price transparency will help drive down those costs, as will consumers becoming more educated about the financial implications of their decisions." Since 2003, insurance has risen 67 percent while the consumer index pay scale has only grown 31 percent, which Mr. Blankinship says is unsustainable. "Healthcare is rising much more quickly than the reimbursement level and it's causing more middle class families not to be able to afford care," he says. "When they need surgery, it's important for them to understand what their financial responsibility will be, and they will need to know how to find alternative options to afford their care." 7. Online pricing attracts medical tourism. If you can price out episodes of care and publish those prices online, you can attract domestic and international medical tourism. "Many ASCs have started to adopt the concept of posting their prices online and we expect that trend to continue," says Mr. Brooks. "They are going to see a tremendous uptick in business because once the payor, employer and patients realize the significant cost differential between the hospital and the ASC — plus the better quality of care and patient experience at the ASC — they will want to take advantage of outpatient centers." The Surgery Center of Oklahoma published its prices online four years ago and has seen increased case volume since then. "It's brought us a lot of business that we would not have seen otherwise," says Dr. Smith. "I think it will catch on and more ASCs will begin publishing prices because people will see it as a way to get business and compete with others." Once the procedures are priced out, you can periodically update prices or decide to publish an adjustable price range so patients aren't surprised with the bill. "As long as you have a range of costs, patients can adjust or plan for their bill," says Mr. Blankinship. "Even if it's a cap price saying you won't exceed a certain amount, patients will be more satisfied."

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