Becker's ASC Review

12 ASC Management 20 Statistics on ASC Staff Hours Per Case By Laura Dyrda H ere are 20 statistics on ambula- tory surgery center staff hours per case based on the num- ber of cases at the ASC, according to VMG's Multi-Specialty ASC Intellimark- er 2012. All facilities Nurse HPC: 6.1 Tech HPC: 2.4 Administrative HPC: 3.9 Administrator HPC: 0.5 Total HPC: 13 Less than 3,000 cases Nurse HPC: 7.1 Tech HPC: 2.6 Administrative HPC: 4.6 Administrator HPC: 0.8 Total HPC: 14.5 3,000 to 5,000 cases Nurse HPC: 6.3 Tech HPC: 2.5 Administrative HPC: 4.3 Administrator HPC: 0.5 Total HPC: 13.8 6,000 or more cases Nurse HPC: 5.8 Tech HPC: 2.2 Administrative HPC: 3.6 Administrator HPC: 0.3 Total HPC: 11.6 n How ASCs Can Benefit From Bundling Episodes of Care By Mary Rechtoris A lthough healthcare is trending toward more transparent payment plans, patients as a whole are generally unaware of the actual costs associated with the entire surgical process. One study found that patients believed their surgeon should receive $14,358 for a knee replacement. ey also believed that Medicare actually reimbursed their surgeon $8,212 for their surgery (J Arthroplasty. 2012 May;27(5):703-9. "Patient perception of physician reimbursement in elective total hip and knee arthro- plasty." Foran JR, Sheth NP, Ward SR, Della Valle CJ, Levine BR, Sporer SM, Paprosky WG.). Chicago-based orthopedic surgeon Blair Rhode, MD, advocates for bundling episodes of care in a free market system in which the patient and the pro- vider, or the patient and a facility, negotiate a price for certain procedures. A patient's entire episode of care encompasses sev- eral different costs, including facility, anesthesia, surgeon charges and postoperative fees, among sev- eral others. e consumer is paralyzed by all these moving parts. "Who can negotiate with the hospital, the surgeon, the anesthesiologist and the implant company?" says Dr. Rhode. "is is why bundled payment plans are an attractive option." Self-insured entities such as union plans or munici- palities could particularly benefit from utilizing bun- dled payments, because they oen operate in a model that does not promote fair pricing. ey generally uti- lize a group insurer as a third party administrator to gain access to their lower contractual rates. e prob- lem is that the third party administrators profit by taking a portion of the net savings. is keeps pricing high as there is downward pressure to achieve lower hospital pricing. "Self-insurers are waking up to this," explains Dr. Rhode. "ey realize they can negotiate with directly with facilities and providers on a price and not pay the third party administrator the juice." Patients with high deductible health plans also may be a viable market for bundled payments. As con- sumers are faced with escalating deductibles, ne- gotiating a bundled fee for an outpatient procedure may be cheaper than using their high deductible in- surance and going to the hospital. A patient that has a $6,000 deductible and needs a knee arthroscopy can likely find a bundled price far lower than their deductible. "is is a definite market that is evolv- ing," says Dr. Rhode. "e consumer has to wake up and start crunching the numbers." Drs. Blair Rhode and William Rhode conducted a study, "Rotator Cuff Repair Facility Costs in an Out- patient Surgery Center and Hospital Setting," that analyzed the varying supply costs associated with ro- tator cuff repair surgery in an outpatient surgery cen- ter versus a hospital-based setting. e study found if rotator cuff repairs were performed at an outpatient surgery center using a wholesale model with stable technology, the net savings totaled approximately $1,775. Surgical supply costs are 4.96 times higher at a hospital using a sales rep model. e study indi- cates that outpatient centers utilizing stable technol- ogy creates a situation where centers can offer a fair bundled price for their services. To implement a successful bundled payment system, alignment between the surgery center and surgeon is crucial. Surgery centers can recruit surgeons for bundled payments through financial incentives. By offering surgeons a portion of the net savings, more surgeons will want to utilize bundled payments, as they benefit the facility, surgeon and patient. Although surgery centers can save a substantial amount of money utilizing stable technology, sur- geons oen dictate what implants they want to use for certain procedures even though they have no respon- sibility for cost. ASCs can lower cost by as much as 80 percent if they utilize stable technology. For a rota- tor cuff repair, the average surgeon Medicare reim- bursement is approximately $960. If a surgery center splits the net savings with the participating surgeon, the surgeon's reimbursement can almost double. is serves as a strong method to align the surgeon with the goal of lowering costs while continuing to provide quality care. "In a bundled payment system, surgery centers can align the surgeon with procedure cost by sharing the net savings," says Dr. Rhode. A problem many facilities face is finding patients, who are oen unaware of the benefits bundled pay- ments provide. Companies who seek patients for bundled payment systems, oen referred to as find- ers, are emerging in the healthcare field. A Chicago- based company, HealthEngine, seeks consumers, primarily self-insured patients. In a system dominated by health insurers and high premiums, bundling episodes of care may be the so- lution to many problems plaguing patients, provid- ers and facilities. However, consumers need to be- come aware of bundled payments' benefits so they have access to affordable, quality healthcare. "e problem is we don't sell ourselves to the con- sumer, we sell ourselves to the third-party insurers," Dr. Rhode says. "In an ideal model, the best way to get value and quality is to have the patient connect- ed to the payment." n Dr. Blair Rhode

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