Henry Miller, PhD, a managing director of consulting firm Berkeley Research Group, has over 45 years of experience in the healthcare industry, including first-hand experience developing payment systems for ASCs.
In 1973, Dr. Miller was involved with the first Medicare demonstration examining whether it should pay facility fees to ASCs. He was also a consultant for Medicare when it was developing its Prospective Payment System.
Here, Dr. Miller weighs in on the top ASC payment trends to watch.
Note: Responses have been edited for style and clarity.
Bundled payments
Bundled payments will have a differential effect on ASCs, Dr. Miller said.
"The bundled payments are not having as much of an effect just yet, mostly because the health plans are not moving rapidly [toward them]. Some may be doing it, but not too many," he said.
Certain procedures and specialties are more attuned to bundled payments.
"ASCs that emphasize or specialize in orthopedic surgery are likely to be more affected by bundled payments because [orthopedic procedures] are more likely to be included in bundles. An ASC that deals with orthopedic procedures should be ready for bundled payments."
Site neutral payments
Payers have little to no incentive to put hospital outpatient departments and ASCs on a level playing field when it comes to payments.
"Site neutral payments is something that has been discussed. I personally don't think it's ever going to happen," Dr. Miller said. "The reason I'm saying that is because there is no motivation on the part of payers to increase payments. If the same procedure is being done in a hospital and an ASC, either they're going to pay the hospital less and the ASC more, and payers just don't want to deal with that issue. I think it's something interesting to talk about, but I think it's going to be too difficult to actually implement on any kind of a grand scale."
Price transparency
Price transparency is an appealing concept for patients with high deductible plans, and it can make ASCs more competitive, Dr. Miller said.
"Some ASCs have been particularly successful in posting prices that are not just transparent, but very competitive. Generally, what it means is that they might accept less for a procedure than if they were not being aggressive about their prices and making them transparent. Overall, they seem to be doing well, and it's something consumers are going to be interested in, especially those with high deductible plans. It's a movement that's going somewhat slowly now, but I think that if an ASC in a specific area adopts an approach in which they list their prices and their prices are progressive, they encourage competition from other ASCs.
Once one ASC starts posting prices online, it encourages others to follow suit.
“One doing it leads to more doing it, and I think it's an activity that's going to grow, and so it's been pretty successful and ultimately for the whole industry, it can't be successful because there's so much volume of ambulatory surgery procedures, and everybody can't lower their price and take advantage of being able to take volume away from other ASCs. I see this whole concept resulting in more competition among ASCs."
Value-based care
The shift to value-based care may not have a large effect on ASCs.
"I'm not a strong proponent of value-based care because it's hard to measure. It's very hard to draw distinctions. The way value-based care seems to be used right now is to introduce quality measures to provide incentives for providers to be more effective and have higher quality and it not having that much effect on price. I think there will be a lot of activity around the concept of value-based care, people will be talking about it, but I don't think it will have much of an impact," Dr. Miller said.