There isn't a single payer contracting approach that will spell success for ambulatory surgery centers this year. Instead, a multi-faceted strategy considering local and regional market dynamics, coupled with preparations for continued healthcare reform implementation, will be the best way to push forward.
"Due to over-reaching cost pressure and payer focus on redesigning benefit plans, reconfiguring provider networks and even advancing their own market positions through consolidation, ASCs should have a multi-pronged approach to safeguarding patient access and enhancing existing service revenues," says Jamison Pearlman, vice president of managed care at Meridian Surgical Partners.
Here are five key considerations when developing your strategy:
1. Out-of-network strategies are being challenged and some ASCs are actively monitoring related business to determine the best time to maximize their OON leverage as well as gauge when it will become more feasible to move in-network.
"ASCs should be constantly re-working any and all agreements for at least yearly COLA adjustments; any agreement that is not in the midst of being re-negotiated and is left alone is really just money lost," says Mr. Pearlman.
2. The most attractive service lines ASC owners and operators can use during contract negotiations are service lines that drive material savings for the payers. These service lines can be used as a broader platform to increase overall facility and enterprise rates.
3. Open negotiations up to include new contracting models that promote value to healthcare stakeholders. "While these performance-based arrangements may be new, they remain the best opportunity to align incentives with payers and realize better rates," says Mr. Pearlman. "Likewise, ASCs should be having open dialogue with ACOs to see how they may fit into overall strategy to manage at-risk patient populations."
4. Keep lines of communication with hospitals and health systems open for strategic partnership conversations. Alignment with hospitals will become more important as networks narrow; ASCs can leverage any relationship they have with hospitals to increase market share.
5. Price transparency will likely benefit ASCs in the future and remains an important opportunity to direct more business toward ASCs. "Beyond patient education, these pricing platforms should also be used to engage employers in places where rates remain untenable and can be used to engage employers directly to help secure local agreements," says Mr. Pearlman. "I would argue that any agreement currently in place where rates remain untenable should be immediately termed; payers generally are not proactive unless the ASC is willing to stand up and defend its own value. A payer will never concede any additional payment."