Many ASCs across the U.S. are seeing patient copays increase for outpatient surgery, and collecting upfront from patients is tough. But it's necessary to keep the ASC running smoothly.
Elisa August, administrator of Brooklyn-based Precision Care Surgery Center and Vice President of the New York State Association of Ambulatory Surgery Centers, joined the BEcker's Healthcare Podcast at the 30th Annual Meeting in October to talk about her center's strategies to collect without hurting the patient experience.
Editor's note: This interview is slightly updated for clarity and length.
Question: Can you tell us a bit about yourself and your career journey in ASCs?
Elise Auguste: Sure. So I started basically out in the ASC industry about 15 years ago. I have actually worked my way up from the front desk all the way to administrator. I currently run a center that does orthopedic spine pain management and podiatry cases out in Long Island, New York.
Q: ASC volume across the country is expected to increase by around 16% through 2032. What are some of the most pressing challenges to maintaining a positive patient experience?
EA: So I would have to say the most challenging is the access and the cost. The issue we're having across the country right now is a lot of states basically are very individualized with the abilities of services that ASCs can provide. For example, in New York, we tend to be a little bit behind the eight ball. For example, our big bush is cardiac procedures. Other states are already ahead of the game doing cardiac procedures, whereas we don't do that currently in New York.
The second thing really is cost. It's upfront cost, deductibles, co-coinsurance. Patients right now don't really understand sometimes what a deductible is, what a coinsurance is when they're signing up for insurance. When they come to the surgeon for space, they're not being charged thousands of dollars for their care and not fully understanding. With the increased desire to go to a surgeon for your surgery and not understanding the cost, sometimes it ends up being prohibitive for patients because they say, 'I know I need this knee scope done' or 'I may need a carpal tunnel done, but can I truly afford it?' And that seems to be the issue they're constantly battling with.
Q: What are some of the strategies that have worked for you in terms of tackling these challenges? What's a recommendation that you have for health care leaders to stay ahead?
EA: In regards to the financial aspect of it, part of it is really educating your patients as well as educating your staff. The difference between deductibles, coinsurances, copays, how they take a part in that patient's care. Being upfront with your patients weeks ahead of time, days ahead of time helps.
If you can't explain, 'You're getting the surgery done. This is the cost you're looking forward to.'
At my facility, we actually provide the patients with a written, you know, documentation saying, 'You're gonna get three different bills, one from your doctor, one from your surgery center, one from your anesthesiologist. Here's all the phone numbers. All the billing departments you can call and get the transparent estimate of how much you expect it to pay.'
We work out payment plans'. We do the best we can to kind of help get the patients the care that they need while not having to hinder their own care because of affordability issues.
On the second hand in regards to access to care, as a state association, I am vice president. I'm working with my state association to push forward for cardiac procedures, different types of procedures that were moving from the hospital space to the surgery center space and working together kind of as a unit. If you're doing it by yourself as one person, there may not be much traction, but there are power numbers. Also, working with the other states that already have programs in place to learn what they're doing and how they did it, how it was successful so that we can copy that.
Q: How can leaders ensure that their staff are well equipped to help patients navigate the financial aspects of their care?
EA: In order to get your staff to really be equipped, it's really on yourself as a leader to make sure that you get all the knowledge possible that you can train your team. I always say your team is the strongest. It should be this link. I take the time to explain to all of my nursing staff, all of my PAT staff: 'This is the different costs patients have because sometimes patients call for the pre op call, and they'll ask the nurse, 'Can you let me know what my deductible is?' And instead of that nurse having to call around, they can say, 'This is what your deductible is. This is what you need to bring in. Because part of this idea that's not my job, no longer should apply. I feel like that doesn't give confidence to the patient.
I don't expect anyone to be an expert, but at least have the basic knowledge of a simple question, you should be able to answer
Q: Did you have to do extra training or anything along those lines?
EA: So I did some extra training with my team. I sat down with the individual department and let them know, you know, you're going to expect these kinds of questions. Also, what I do, I'm very big on documentation. We do everything from, case costing ahead of time. You know, we break down the insurance payments and estimates.
We give it to the nursing staff. They know where to find it within the system. If they have questions, my door is always open so I can kind of explain it. You know, even for patients, I get calls all the time from patients asking to walk them through their responsibility.
I've had patients call crying and say, 'I need my surgery, but I'm scared because I'm gonna have to pay this amount of money. I'm gonna push it off because I can't afford it.'
And I said, 'Wait. Wait. Wait. There are options. Let us talk it out. Let me help you. How can we figure this out?'
Q: Is there anything else you'd like to add or talk about?
EA: I would say, honestly, it's just to be patient and understanding with your patients. I do understand running a surgery center sometimes is that we kind of get lost in trying to make profit all the time because, you know, at the end of the day, revenue is what pays the bills and keeps everything going. It allows for you to kind of expand the business. However, sometimes we also have to remember why we got into the business, and it's truly about patients and their care and making sure that they're getting access to what they need.