Becker's ASC Review

56 Coding & Billing If ASCs resist narrow network participation, while physicians thirst for it, the ASC will even- tually lose. By the time a surgery center decides to join up, negotiating more attractive rates may be more difficult or it may be too late entirely. "It is paramount that ASCs engage their physi- cian leadership on their overall healthcare deliv- ery strategy," says Mr. Kinsley. "Joining a narrow network or any network is only valuable when synergies exist between all medical professionals associated with the ASC." ASCs are small players on a vast field; hospitals and health systems wield significantly greater clout. "For narrow networks, payers want a nar- row scale solution. Instead of going to indepen- dent providers, they go to an integrated provider. This is where we are finding ASCs are getting locked out," says Mr. Winslow. "Not everyone is in the network. That is managed care at its essence." Leaning in There are bigger players in the healthcare market than ASCs, but surgical centers hold a unique bargaining chip for insurance companies: their lower cost and higher quality. "Narrow networks include low-price providers or they give incen- tive payments to providers who meet certain quality metrics," says Mr. Kinsley. Surgery cen- ters have demonstrated consistency in quality outcomes and low costs, a perfect fit for the nar- row network criteria. Use that data to leverage rates that will make contracting with a narrow network beneficial. "Apply the same criteria you would apply for any contracting decision," says Mr. Winslow. Consider issues such as: • Potential volume • Reimbursement rate • Referral patterns Oftentimes narrow networks will offer exchange rates below Medicare. If the numbers just don't add up, treat it like any other business decision. "Choosing not to contract with a health plan's nar- row network product is an operational decision that involves risk, but is not much different than similar decisions healthcare providers make to ter- minate agreements or not contract and operate un- der an out-of-network structure," says Mr. Kinsley. Looking forward Predicting the future can be an exercise in futility, especially when it comes to healthcare, but ASC leaders must make an educated guess. "We may have a push back, like we did in the 1990s, but short-term we won't see that," says Mr. Winslow. Narrow networks are focused on cost containment and the need to drive down the price of healthcare may be one point everyone can agree on. For the time being, narrow networks are here to stay. "The ultimate success rests with an ASC's ability to provide a value proposition to the community through its relationships with physicians and health insurance plans," says Mr. Kinsley. "ASCs have tremendous value in the healthcare space as we move away from fee-for-service and demand transparency and cost-effective care." n "The ultimate success rests with an ASC's ability to provide a value proposition to the community through its relationships with physicians and health insurance plans. ASCs have tremendous value in the health space as we move away from fee-for-service and demand transparency and cost-effective care." – Stephen Kinsley, Senior Director of Managed Care at Surgical Care Affiliates Becker's ASC 21st Annual Meeting - The Business and Operations of ASCs October 23-25, 2014 • Chicago Keynotes: Terry Bradshaw, Co-Host and Analyst, FOX NFL Sunday and NFL Legend; Bill Taylor, Founding Editor, Fast Company and Best-Selling Author; Lolo Jones, 2-Time Olympic Hurdler and World Champion, 2014 Olympic Bobsledder For more information, call (800) 417-2035 30 Great Surgeons, 36 Leading Administrators and 80 Surgery Center Speakers in Total

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