Issue link: https://beckershealthcare.uberflip.com/i/274954
62 Coding & Billing YOU CANNOT AFFORD TO LOSE MORE REVENUE! www.smpsd.com | 605.444.8207 | info@smpsd.com Providing Custom Solutions Experts in Customized Revenue Optimization Billing | Coding Coding Reviews Managed Care Contracting Revenue Cycle Audits Fee Schedule Analysis Call the Expert in Revenue Optimization "Reach out to payers and notify them of your in- terest in ACOs," says Ms. Kehayes. "Find out from the payers if they are actively pursuing an ACO in your marketplace and if so, by whom? Approach the hospital/healthcare system of your interest to subcontract with the ACO and your ability to of- fer them savings for outpatient surgery." Many providers are consolidating to increase market share and build strength during payer ne- gotiations. "As healthcare systems enter into gain sharing contracts with payers, ASCs have the potential for opportunity to increase reimbursement via align- ment with healthcare systems as a cost effective site in the healthcare system," says Ms. Kehayes. "As healthcare systems continue to grow, by ac- quiring ASCs and physicians, the alignment of ASCs and their surgeons with a system may be critical to their future success." As downward pressure on healthcare costs con- tinue, insurance companies will be interested in working with physicians and ASCs to demon- strate savings. They will continue to look for new specialties to move from the hospital setting into outpatient ASCs safely and effectively, including spine and total joint procedures. "If you are in a state that allows overnight recov- ery care, that can enable the center to move bigger cases out of the hospital and if the ASC has sur- geons that are willing to move bigger cases, con- sider setting up overnight recovery care to enable access," she says. "Approach payers to set-up con- tracts that will motivate movement of the cases out of the hospital." Market consolidation: Hospitals and health systems are employing primary care physicians and specialists to gain market share and participate in ACOs. As a result, ASCs have a smaller pool of physicians to recruit and may consider aligning, partnering or joint venturing with a hospital or health system. "A joint venture may be advantageous to sustain ability to contract and access to volume due to increased employment of physicians," says Ms. Kehayes. In addition to help with managed care rates, hos- pitals that joint venture with surgery centers may allow employed physicians to perform cases at the center. Primary care physicians employed by the hospital may also refer cases to surgeons working at the ASC since the center is now within their network. ASC success: There are several steps forward- thinking ASC administrators and owners can take now to prepare for the future. Ms. Kehayes out- lines a few of the key concepts and opportunities to consider: • Add spine, total joint and other higher acu- ity cases to your ASC if the clinical condi- tions and operations permit. • Align the ASC for contracting with ACOs. • Joint venture with a healthcare system to sustain and enhance strength in negotia- tions and access to patient volume. • Your ASC may present an opportunity for healthcare systems to joint venture and en- hance their relationships with payers via clinical integration. • Prepare for price transparency demands prior to performing surgery. ASCs that wish to remain independent may find an unlikely bedfellow in insurance companies paying high prices to local hospitals. Payers un- derstand that ASC rates are considerably lower than even hospital outpatient department rates. If the ASC can't survive at current reimbursement levels and communicates to the payer that it must sell to the hospital, there is an opportunity to suc- ceed at capturing rate increases from the payers to sustain independence. "Working with payers in markets where there are large healthcare systems to direct care out of the hospital/health system and into the ASC [is an opportunity]," says Ms. Kehayes. "Payers are interested in having ASCs maintain their inde- pendence and may be willing to help if they feel the ASC is a potential target for acquisition by a healthcare system." n