Shannon Yarrow, senior vice president of managed care at Brentwood, Tenn.-based Surgery Partners, joined "Becker's ASC Review Podcast" to talk about reimbursement opportunities for physicians doing outpatient procedures.
Note: This is an edited excerpt. Listen to the full podcast episode here.
Question: Are there physician reimbursement opportunities available in the outpatient setting? How can physicians work with surgery centers to maximize some of those opportunities, whether they're bundles or other ways? How can physicians benefit from the movement to outpatient?
Shannon Yarrow: In some of the largest payers around the country, what we're starting to see is that they will change their physician fee schedule and provide an enhanced reimbursement if the site of care happens to be an ASC instead of a hospital outpatient setting. That's one way, but there are some additional creative ways that physicians can enhance their reimbursement.
Even if the payers don't have a specific site of service incentive program, it's an opportunity for you to talk with them about the savings that will be generated when you start to move those cases. Ask how you can share in the savings with that payer.
For example, if I was doing hundreds of orthopedic procedures in the hospital last year, but now 50 of them are going to move to an ASC, I can try to estimate what the differential is for the facility costs and share that with the payer and say, "I'm going to save you this many thousands of dollars. Can you give me an incentive for that? Maybe I can get a better rate on my physician fee schedule? How can we work together, because I'm going to help you [save money]?"
Lastly, what I've seen is where physicians are using ASCs currently. Let's say you're a GI group and you actually do most of your cases in the ASC. One of the unique things that I've seen from some of the payers in the Northeast is they will actually give you a percentage each year and say, "Okay, GI group, you did 80 percent of your procedures in an ASC. If you can at least keep your 80 percent figure, or you can do a certain percentage that continues to save us money, then we can actually reward you with shared savings."
Maybe on a quarterly basis, you look at how much was saved and you share those savings and they can give you some incentive bonuses. So those are some unique things that we've seen that are real opportunities for physicians who are using ASCs to enhance the reimbursement with those payers.