New and interesting and complex procedures such as cardiology, orthopedic and spine are being performed in ambulatory surgery centers (ASCs) which makes this a particularly interesting time for the space.
The trends driving these more complex procedures into the ASC setting include cost savings, technological advancements, convenience, safety and outcomes, as well as an aging population. The good news is that patients, providers, and payers/employers all benefit. For those looking for opportunities to grow your ASC, here are seven critical steps that should be considered.
1) Develop solid clinical protocols. It all begins with selecting the right patients. ASC administrators should put some thoughtful consideration about who their ideal patients are; those that will be best served by having their procedure done in a surgery center. Consider their age, BMI and health history. Next, begin developing or work with someone to develop a best practices playbook from the clinical standpoint from pre-op to the day of surgery and, finally, post-op. Look at technology and determine if the ASC is designed to handle cardio and ortho cases. The main idea is to create a great patient experience so remember to include clear instructions on what they should do once they are back home.
2) Establish a patient outreach program. How do you get more patients to come to the surgery center instead of the hospital? First, there is some education that needs to take place at the physician’s office. Frequently, patients are asked, “Do you want to have this procedure done in a hospital or a surgery center?” There is no explanation of what that means. Patients are not provided critical details such as the pros and cons of each facility, what the patient’s financial responsibility will be, does the facility have a good track record with this procedure. We have a lot of opportunity to educate in those areas. From a marketing perspective, a website with patient testimonials and success stories, social media outreach, even a podcast that helps to bring awareness to ASCs can be powerful. Often, ASCs have good relationships with the medical device and implant companies and some of those organizations have significant budgets that can help market your ASC by helping you reach out and build your patient base, especially once you have invested in their technology.
3) Negotiate managed care contracts. When it comes to these complex procedures such as cardio, ortho and spine, it is very likely that your managed care contracts will be ineffective in terms of the language as it relates to these types of procedures or might have very dated reimbursements. It is important to really look at your contracts and know what you have so you can negotiate more effective terms.
4) Create strong front-end processes. Ensure your ASC has really good processes on the front-end by addressing the following:
• Does the patient meet the pre-surgery requirements?
• Do you have a good process for obtaining pre-authorization and verifying benefits?
• Do you have a process for gathering the necessary demographic information?
• Do you have a clear understanding of the payer’s medical policy?
• Do you have a good assignment of benefit form and registration packet? This will ensure that you have all the information necessary so you can get paid on the backend.
You are investing a lot on the front end from a technology standpoint and you are investing in the implants. You deserve to get paid.
5) Provide financial counseling for patients. It is common for patients to have to pay some portion of their procedure. However, not all patients understand their insurance plan, what is covered, what their portion will be and when that payment is due. Having someone available to talk through how everything works with the patient and educating them from a financial perspective will make for a better experience for the patient and help to ensure that the ASC is getting paid.
6) Ensure effective revenue cycle processes. After investing a considerable amount of time, effort, and money to build your surgery center and developing best practices, it is time to make sure you reap the rewards of your efforts by making sure you get paid. One of the best ways to do that is to make sure you have strong coders that understand these specialties, specifically, the new ones you want to add. Coding incorrectly will lead to denials or underpayments – or overpayments which becomes a compliance issue on the other end. Implant billing is a huge challenge that National Medical sees across the country. Big dollars are lost or left on the table from that standpoint. Having a tight process for accounts receivable is necessary to ensure you maintain good cash flow.
7) Use sophisticated analytics to help determine success. Data is an important way to determine what is working for your surgery center and, maybe more importantly, what is not. You can have analytics that surround and support the procedures being done. You can see detailed daily, weekly, monthly reports that allow you to track the performance of those specialties. You have KPIs on your days to bill for your case as it relates to your implants. Analytics help you to determine what your cash per case is, your denial rate and how many implants are sitting out there that have not been paid. Those are big dollars that should not be left on the table.
This is an exciting time of growth for surgery centers. High growth and high margin procedures will increase attractiveness and valuation of your ASC. You can remain independent and fund your growth opportunities internally with the higher cash flow brought in by adding new and complex procedures or you can partner with a local hospital to help increase referrals. Finally, you could partner with a private equity firm to fund aggressive expansion to drive value.
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