Successful negotiations and favorable contracts with payers is the first step before surgical centers can sustainably function and grow, and navigating this process can be difficult and time-consuming.
Amol Soin, MD, owner and medical director of Ohio Pain Clinic, based in Centerville, told Becker's his biggest obstacle he has faced as a pain management physician has been finalizing a contract providing adequate funding for the use of implantable devices.
Dr. Soin said it was a "huge challenge" to attain a contract with a carve out for implantable devices, and it took years of back-and-forth negotiating with payers before eventually compromising.
Physicians at clinics and surgical centers have been facing increased pressure to keep up with the latest technology across the ASC industry while competing against hospitals. Meanwhile, costs surrounding reimbursements from federal, local and private insurance do not cover the overall price paid by ASCs in numerous cases, Melissa Waibel, BSN, CEO of Tamuning-based Guam Surgicenter, told Becker's in a July 14 report.
The high cost of disposable devices combined with the "cumbersome and time consuming" regulatory requirements pose heightened obstacles for ASCs to progress in the healthcare industry, according to Ms. Waibel
The standard contract may not cover the devices preferred by physicians or patients, making physicians like Dr. Soin spend more time negotiating a carve out for these expensive devices, which may take away from time spent on other tasks within the pain clinic.
While procedures are typically less expensive when performed at an ASC versus a hospital outpatient center, ASCs face margins that are typically smaller and more challenging to establish, meaning viability is determined by operation efficiency and costs, Josh Troast, director of ambulatory surgical services for Muskegon (Mich.) Surgical Associates, told Becker's July 24.
With persistence, however, ASCs can get a satisfactory contract, according to Dr. Soin.
"I overcame it with patience, time and negotiations. I didn't sign the first contract offer and went back and forth a few times over a few years before we found middle ground," Dr. Soin told Becker's.