Becker's ASC Review

Coding, Billing & Collections 39 Price Transparency is Coming: 10 Things for ASC Leaders to Know By Laura Miller A trend toward price transparency in healthcare is sweeping the country and ambulatory surgery centers are in a prime position to benefit. However, they must take advantage of this opportunity to truly compete with other providers in the healthcare market. "ASCs that post their prices will have to make decisions about how they want to deal with managed care," says Mr. Brooks. "If they are also contracted with private payors, the insurance companies will want the self-pay rates as well. Some facilities might decide to opt out." "Price transparency is going to put ASCs in a great position and make a difference for them across the nation," says Bud Brooks, vice president of development of Surgery Center Network. "They are unable to depend upon surgeons nearly as much to bring case volume because hospitals are purchasing physician practices. ASCs have to do something to market directly to their customers, which are now payors, employers and patients." The same principle applies for out-of-network cases at the ASC. Traditionally, ASCs billed OON at similar rates to hospital procedures, eliminating their price advantage. Healthcare works differently from other industries because of the veiled pricing, but with incentives to lower the cost of care, increasing premiums and trends toward self-funding, people want to know what their healthcare will cost before they purchase it. "It's a national issue because the healthcare system is so broken and messed up that there's nothing that could bring prices down any better than for people to be honest and upfront about their prices," says Keith Smith, MD, administrator of Surgery Center of Oklahoma in Oklahoma City. "I see it as an issue that could actually be good for business — it has been good for our surgery center. There will be an improvement in quality and plummeting in prices; it happens in every other industry and healthcare is no different." "When ASCs bill for OON, they anger the patient and the payors, which will ultimately be the employers," says Mr. Blankinship. "The employers' attitude will be if the ASC is billing like the hospital, they might as well keep surgeries in the hospital." 3. High deductibles drive patients to low-cost settings. The insurance market is changing. High premiums have become standard and fewer companies are satisfied with PPO plans "Employers have had enough with rising premiums and healthcare costs, and they can only shift so much of that to the employee contributions," says Mr. Brooks. "The deductibles are so large that they need to rethink the whole model." Here are 10 things to know about the trend toward pricing transparency and how to position your ASC as a leader going forward. 1. ASCs can be more competitive in the consumer-driven market. As people take more control over their healthcare dollars, consumerism will drive more patients to low-cost outpatient settings. They will pay more attention to price and look for better quality. "Price transparency will be better for healthcare overall. It's going to create an open market and competitive environment where just because you are the most expensive doesn't mean you have the best quality," says Jeff Blankinship, president and CEO of Surgical Notes. "That's a real concept that will be more prevalent in healthcare. You are going to find out that in the future, surgery prices will be more competitive on both the consumer and provider side." Surgery centers owned by physicians will likely have a huge advantage over big hospitals because by owning their own facility, the physicians eliminate higher facility fees. "That makes them difficult to compete with because most physicians are satisfied with the healthy professional fee; they don't need to hit a grand slam on the facility fee," says Dr. Smith. "If you have transparent pricing, you can actually have meaningful competition where consumers can determine some meaning of value. My price may have to change when I have more competitors, which I hope will be soon. We look for a healthy price war; I think that's what this country needs and is long overdue." 2. Transparent pricing could eliminate managed care all together. While ASCs could drive additional volume by publishing their prices, it could spell trouble for their traditional managed care contracts. If the insurance companies know what you charge for self-pay, they may not want to pay higher rates. Provider Contracting Services Reimbursement experts Provider Business Services Optimizing opportunity ASC Operations Compliance & Consulting Services Preparing for excellence Eveia's Clients: · Ambulatory Surgery Centers · Surgical Hospitals · Health Systems with ASC Relationships · Physician Practices · Anesthesiologists For more information, call 425-657-0494 or visit our website at www.eveia.com

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