ASCs have an inherent value proposition when negotiating new contracts or renegotiating existing contracts, according to Healthcents CEO Steve Selbst.
Here are his top three strategies for maximizing payer contracts:
Note: Responses have been lightly edited for style.
1. "Focus on the value of keeping surgeries and procedures in the ASC versus referring them to a hospital for outpatient services. Usually, the savings of handling a service in an ASC is three to six times the savings compared to performing the same service in a hospital."
2. "[Consider] carve outs. The ASC Medicare fee schedule is wage indexed using a similar approach to the prior Medicare "grouper" method, where groups of common procedures are reimbursed at the same wage indexed rate in a specific geographic region. If you have certain procedures that are critical, [meaning they] represent a high percentage of your utilization or revenue, list these procedures separately and ask for specific rates. Intraocular refractive eye surgeries, hip replacements and hand surgeries may be examples of procedures that a single-specialty or multispecialty ASC would carve out. Also, many payers continue to use groupers, not necessarily correlated to the prior Medicare grouping of codes. As such, if you have a high concentration of services to fall into a small number of groupers, it is a good idea to focus on negotiating those groupers only and leave the others flat or down slightly, if necessary. Keep the focus where it needs to be: codes and services with high utilization."
3. "[Ensure] that implants, multiple procedures and bilateral procedures are reimbursed. Depending on the payer, implants may be presumed to be a part of the grouper/code reimbursement. As such, you will need to assure reimbursement is high enough in those codes/groupers to compensate for implants. If possible, try to 'carve out' implants at cost plus shipping cost plus 10 percent uplift. The Medicare standard for multiple procedures is 100/50/50. That is, 100 percent for the primary service and 50 percent of the primary service for the second and all subsequent procedures. This is a good standard to mirror. Shoot for 175 percent of the primary procedure if you are doing bilateral procedures, [such as] hip replacements on both sides."