Rami Abbass, MD, is a physician involved with an endoscopy-focused ASC, overseeing payer negotiations for five years. He has seen increased deductibles and focus on reducing the national healthcare spending make reimbursement more difficult. However, the ASC's quality and cost advantage make the facility attractive to payers and consumers.
"The difficulty is for an individual ASC to have enough voice in the market to educate payers and consumers on this advantage," says Dr. Abbass. "The key is to develop a relationship with your payer negotiators which results in regular communication. I ask payer negotiators to visit our ASC and learn about the operation and they have been open to this and gave given us very positive feedback."
ASCs are typically already lean and efficient organizations, but it's important to find additional ways to add value to the healthcare equation. This is especially true as payers consolidate and gain more leverage over providers. While Dr. Abbass hasn't seen any changes due to the consolidation, the long-term impact of reduced competition among payers could be negative.
For now, Dr. Abbass is able to gain the payers' attention by demonstrating value.
"We have had great success demonstrating this value in four broad categories of improved patient experience, quality of care, utilization optimization and access to care," says Dr. Abbass. "Payers are increasingly interested in all of those and are interested in rewarding initiatives that improve on them."
Here are the four areas of focus:
1. Demonstrating patient satisfaction data. The surgery center tracks patient satisfaction with high survey return rates. The surveys are electronic to optimize convenience. "In our ASC we have created an atmosphere where the patient comes first — from registration to recovery," says Dr. Abbass.
The center took these steps to create a better patient experience:
• Adjusting procedure pre-call time to allow for questions and medication adjustments
• Switching to online surveys with real time results
• Collecting and demonstrating data showing employees you value patient experience
2. Demonstrating quality to payers. Quality data is increasingly valuable to payers, especially during contract negotiations. "In our ASCs we have been part of a national data registry for about five years," says Dr. Abbass. "We collect every endoscopist's adenomatous polyp detection rate and compare it to national benchmarks. We measure colonoscopy completion rates, withdrawal times and adequacy of colon preparation also to compare to benchmarks."
The payers are interested in initiatives to compare quality of care delivered at the center's different sites. The data collection and benchmarking allow the centers to identify issues and make adjustments to improve outcomes.
"Preparation instructions were adjusted and simplified to improve on colonoscopy preparation," says Dr. Abbass. "Studies show that endoscopist polyp detection improves when data on detection is collected."
3. Demonstrate proper procedure utilization. Payers are interested in long-term cost savings. "We demonstrate to payers an internal peer review process where approximately 10 percent of our procedures are reviewed by peers to show adherence to clinical standards/national society guidelines within our specialty. This minimizes unnecessary procedures which payers want to reward."
4. Demonstrate the ability to improve patient access. ASCs can improve patient access with shorter wait times and an eye toward convenience. "We have an open-access process for screening procedures that allows patients to undergo procedures directly without office visits, reducing cost and improving convenience," says Dr. Abbass. "We also added an additional site to reduce commuting time for patients."