Becker's ASC Review

61 Coding & Billing Healthcare reform implementation will be in full swing next year, and Ms. Kehayes says a few of the biggest concerns for ASC administrators and physi- cian owners include: • Hospital employment of physicians; • Payer reduction in reimbursement with changing payment methodologies; • Declining out-of-network access; • Hospitals/health systems and payers collaborating on accountable care organizations. Based on the primary concerns, here is how Ms. Kehayes sees a few of the biggest challenges playing out in the coming year: health insurance marketplaces: The Obama administration is pushing forward with fixing the glitches in healthcare insurance exchange websites and maintained coverage requirements for 2014. Uninsured individuals will be mandated to purchase insurance or pay the penalty for next year. "With the implementation of health insurance marketplace 'exchanges,' employers, in addition to the un- insured, will have the opportunity to shop on the exchanges," says Ms. Kehayes. "Traditional commercial business may start to move toward exchange products. Payer reimburse- ment under the exchange products is being offered, in many instances below commercial rates, with some offering rates comparable to Medi- care or Medicaid as a result of health- care reform, despite the fact that premiums will be paid to the insur- ance carriers for participation by the member." As a result, Ms. Kehayes sees a potential negative shift in reimbursement as the traditional commercial payer moves to the exchange products, even though there will be increased access to insurance. "Therefore, consideration and negotiation of exchange products are very important for ASCs to pay attention to in 2014 and in the future thereafter," she says. new payment models: Healthcare providers are collaborating with in- surance companies on new payment models such as accountable care orga- nizations and bundled payments. There may be opportunities for ASCs to align with payers on bundled payments and move cases from the hospital to the outpatient surgery center, says Ms. Kehayes. These payment models pass risk from insurers to providers and patients. If ASCs have surgeon alignment, they can approach ACOs as a subcontractor to offer a savings for outpatient surgery. Healthcare Reform: Impact on ASC Managed Care Contracting (continued from cover) Naya Kehayes "As health systems enter into gain sharing contracts with payers, ASCs have the potential for opportunity to increase reimbursement via alignment with healthcare systems as a cost effective site in the healthcare system. As healthcare systems continue to grow, by acquiring ASCs and physi- cians, the alignment of ASCs and their surgeons with a system may be critical to their future success." — I. Naya Kehayes, Founder and Managing Principal of Eveia health Consulting & Management

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