Becker's ASC Review

29 Coding & Billing Collaboration with payers Even though payers are coming around to paying for the higher acuity cases in ASCs, they still aren't warming up to new partnerships or opportunities that benefit outpatient centers. "There is little to no opportunity for ASCs to work with national payers on a large scale," says Ms. Woodell. "There have been some great ef- forts to lower payments with accountable care organizations, and that is typically pursued in the format of capitation. That is controlled by the independent physician associations and hos- pitals. Unfortunately, the ASC remains on one of the lower rungs for payment and those sub capitated agreements remain among the lowest paying contracts." Additional incentives, such as bonuses on suc- cessful cost containment efforts, are not typi- cally extended to ASCs. Within ACOs, the bonus payments typically stay with the physician and hospital. Self-funded employers But it's not all doom and gloom for ASCs; there are still new opportunities emerging with large employers and other organizations to partner as the high quality, low cost provider. "Employers have struggled to take a more active role in driving patient care for a few years, and now that's coming to fruition," says Ms. Woodell. "Employers and brokers are adding a hidden level of benefits for patients to use their 'preferred' pro- viders. The patients still have their regular plan with in-network deductibles, but there are certain surgeries triggering a higher level of benefit where procedure costs are extremely variable.There are a few companies that have created a narrow panel of providers and established bundled rates to work with employers on developing deals for their patients." The bundled plans for employers are attractive because: • Employers have one bill to pay • They know what the cost will be upfront • The cost is less than sending the patient to the hospital "The employer incentivizes the member to their preferred provider by waiving out-of-pocket fees," says Ms. Woodell. "The patient might drive a few hours and stay overnight in a hotel before and af- ter the procedure. One of our centers has received over 25 cases this year from employer referral. We are going to see a lot more of this in the future." Future trends There are several trends in healthcare that will benefit ASCs in the long run. These trends to watch include: • Increasing price transparency • Continued shifting costs to patients • Healthcare education for patients about life- style choices • Educating patients about their benefit level options "Not only are patients going to know more about the difference between in-network and out-of- network centers, but they are going to know more about the ASC versus the hospital outpatient cen- ters," says Ms. Woodell. "They might see a plan where their deductible is 20 percent in the HOPD and 10 percent in the ASC. It takes a long time for some for some payers to switch the benefit plans, but with others it's easier." n Andrea Woodell AmSurg's third quarter net revenues were $503.2 million, up 91.3 percent from the third quarter of 2013. AmSurg also exhibited 110.4 percent growth in adjusted EBITDA to $95.9 million. Glendale (Calif.) Adventist Medical Center has reopened the Physicians Ad- ventist Surgery Center as a joint venture, with local physicians as stakehold- ers and ASD Management as the managing company. Foundation HealthCare reported $27.4 million in revenue for the quarter, up 16 percent from the third quarter of 2013. Hospital Corporation of America posted revenues of $9.22 billion in the third quarter of 2014, up 9 percent from the same period last year. Merritt Healthcare opened its Western Connecticut Orthopedic Surgical Center in Danbury, Conn. Pinnacle III added three new employees to its management team this year including: • Holly LeRoux as director of operations at Boulder (Colo.) Community Musculoskeletal Surgery Center • Jebby Matthew as director of operations at The Orthopaedic & Spine Center of Southern Colorado in Colorado Springs • Linda Deeming as director of operations at Foothills Surgery Center in Boulder, Colo. The $792 million Surgery Partners acquisition of Symbion closed, but as required by the Federal Trade Commission, Surgery Partners will divest Blue Springs Surgery Center in Orange City, Fla. Los Angeles County-USC Medical Center has formed a strategic alliance with Surgical Care Affiliates to manage several of its surgery centers. Surgical Care Affiliates announced its financial results for the third quar- ter of 2014. SCA's total net operating revenue, excluding facilities in which the company owns a non-controlling interest, increased 13.1 percent, from $194.4 million in the third quarter of 2013 to $219.9 million. United Surgical Partners International reported $159.2 million in net rev- enues for the third quarter, up 5 percent from $151 million in the previous year's period. Operating income was $64.4 million, up 2 percent from $63.1 million over the same period in 2013. n 10 Recent ASC Company Updates By Carrie Pallardy

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