Issue link: https://beckershealthcare.uberflip.com/i/381883
55 Coding & Billing Shouldn't having more information make you smarter? We were promised a world where medical records were digitized, simple, & intuitive. Electronic Health Record solutions that have emerged have room for improvement – especially in acute care, high mobility settings like anesthesia where they are distracting and cumbersome. For administrators, EHRs are expensive and most neglect their ultimate value: to provide the analytics needed to improve operations and the overall patient experience. Graphium Health's AnesthesiaEMR™ solution will show you there's a better way. Mobile. Intelligent. Connected. PeriOperative Analytics Pen & Paper Simplicity AnesthesiaEMR TM www.GraphiumHealth.com T he phrase "narrow networks" is fraught with different meanings, but for all providers it conjures the idea of exclusivity. You are either in or out. Do ambulatory surgery centers stand to profit from these exclusive networks or are they destined to be shut off from the promised benefits of this trending model? Defining the narrow network What constitutes a narrow network, like so many ideas in the new healthcare landscape, is subject to opinion. Before rushing to make a strategic judgment to join or abstain, it's important to understand the core concept. "The generally acknowledged definition for a narrow network is an insurance plan developing a network that contracts with less than 70 percent of the hos- pitals within a well-defined area," says Stephen Kinsley, senior director of man- aged care with Surgical Care Affiliates. The majority of narrow networks have sprung into existence as a result of the health insurance exchanges mandated by the Patient Protection and Affordable Care Act, whether public or private. Impact assessment Thus far, the healthcare field is hesitant to judge what effect these narrow net- works have had. Payers exhibit similar caution in launching these networks; they have not become the sole, or by any means main, network model. "We are finding in most markets that payers participating in exchange plans will run a dual network. They will maintain a broader network, which oftentimes ASCs are already a part of, alongside a narrower network," says Marty Win- slow, director of reimbursement with Nueterra. The highest concentration of narrow networks is, unsurprisingly, in urban areas. The high levels of physicians, hospitals, ASCs and other providers lend the market to this model: everyone can afford a little exclusivity. "On the other hand, rural exchanges are built on existing networks. These areas are using larger, traditional managed care networks," says Mr. Winslow. Even in densely populated metro areas, narrow networks have had a minimal impact to date. Some ASCs have not been invited to join these networks, while others continue to wait to see how it pans out — either good or ill — that will determine their stance. A good portion of Nueterra centers, are contracted with these narrow networks to some extent, perhaps with one plan but not another. Neither scenario has dealt a crushing blow or sweeping victory to ASC business. Forced in or shut out? Narrow network structure and provider response will vary widely from mar- ket to market. It's up to ASC leaders to analyze the market and their center's position. If unprepared, ASCs can either be cut out completely or wrangled in at unattractive rates. ASCs serve two sets of customers: patients and physician, and these two groups of people are a significant influence. If more and more patients are absorbed by narrow networks, physicians and by extension their ASCs will want and eventually need access. "Physicians who join narrow networks with an incen- tive tied to quality will push for their ASC to join these networks too," says Mr. Kinsley. "There is a steady evolution of aligning with physicians and other post- acute providers to offer these services within narrow networks." Narrow Networks: ASC Industry Boon or Bane? By Carrie Pallardy