ASCs are struggling to meet margins as procedures continue to migrate to the outpatient setting but reimbursements stagnate.
April Aud, RN, BSN, the administrator of Black River Ambulatory Surgery Center in Poplar Bluff, Mo., joined Becker's to discuss the danger of declining ASC reimbursements and how her team is approaching the disparity.
Editor's note: Responses were edited lightly for clarity and length.
Question: What ASC/outpatient trends are you the most nervous about? Which are you the most excited about?
April Aud: This question has a double-edged sword answer. I am most nervous about all the new procedures that are allowed in the ASC setting from a reimbursement standpoint. Insurance companies have been trying to push certain procedures towards the ASC, which is great, but will reimbursement catch up? ASCs are such a benefit to the medical community, but getting Medicare, Medicaid and commercial payers to catch up is the hardest part.
What I am most excited about would be all the new procedures that are allowed to be performed in the ASC. It is no secret that ASC's are beneficial to patients and the communities they serve. Obviously, there will always be a need for inpatient surgery, but why not focus on opening up some of the inpatient operating room space by sending those cases that can be done in the ASC to the ASC? Typically, there is a much lower cost to the patient, faster turnaround time and often better outcomes.
Q: What are the long-term ramifications if these reimbursement declines continue?
AA: Well, unfortunately, everything is getting more expensive — supply costs, practice costs, salaries for employees, etc. — but insurance companies don't want to pay anymore, so margins are very, very thin. I worry that eventually, small ASCs in small towns or markets are not going to be able to make it because they can't afford it. Especially because these smaller ASCs often have a lot of Medicare patients, the reimbursement there is not sufficient and there's a limited number of commercial patients. I worry that a lot of small ASCs that serve communities that really need the ASCs in the area are not going to be able to survive. And as bad as it is to talk about the monetary side of it, you have to.
Q: What strategies are your team using to combat these disparities?
AA: Right now we're focusing on going through all of our contracts with a fine-tooth comb — making sure that what our contracts say is what we're getting reimbursed. What's coming up a lot is insurance companies denying reimbursement for silly reasons. They will make you fight and fight just to get reimbursement. If you don't have employees who are willing to do that, you're going downhill in the reimbursement department. It sometimes feels like insurance companies deny reimbursements hoping that you won't fight it, but you have to make sure you do.