As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers.
Cash-pay service models at ASCs can vary — some provide cash-pay services at a discounted rate while others figure a percentage above Medicare rates.
In July, Manitowoc, Wis.-based Renovo Health opened the door to a new direct-pay ASC to offer affordable surgical care.
"We set ourselves apart through our excellent staff, as well as through our pricing structure," Dr. Johnston told WFRV. "Our direct-pay pricing structure allows us to pass on cost savings to employers and patients in a dramatic fashion."
For a decade, president of Scottsdale-based Arizona Institute for Sports Knees and Shoulders David Bailie, MD, has run a practice built on his own reputation with no ancillary revenue streams and limited insurance contracts.
He previously worked for a large group that was purchased by a hospital system, but after beginning his own practice he shed ties with large insurer contracts.
"Be fair and transparent — don't price gouge," he told Becker's. "If you've been in practice long enough, you know what you're getting paid from insurance, and you know what you think is fair. So for rotator tear costs, I have a small, medium, large and massive fee schedule. If I get into a medium-sized tear and I already charged the patient, and it's way worse, I don't change the [price]. That's my risk for not being able to figure that out ahead of time. I'm fair and transparent with everything. I turn a lot of people away from surgery who are willing to pay because I don't think they need it … Over time, that reputation gets even stronger."
Other ASCs and physician practices are opting for direct-to-employer contracting, another model that offers the ability to eliminate the payer from the care process.
"I believe direct-to-provider contracting between employers and physician practices should be getting more attention as the cost of healthcare continues to rise," Nicholas Grosso, MD, an orthopedic surgeon at the Centers for Advanced Orthopaedics in Bethesda, Md., told Becker's. "Employers are feeling this increase and have no choice but to pass costs down to employees."