ASCs in many markets are struggling to secure higher reimbursements and gain leverage in payer conversations.
Tracie Hark, administrator of Hannibal-based Northeast Missouri Ambulatory Surgery Center, joined Becker's to discuss how payers are justifying ASC reimbursement cuts.
Editor's note: This response was edited lightly for clarity and length.
Question: What do payers say when you're asking for higher reimbursements?
Tracie Harker: When asking for higher reimbursements, payers typically say, "You're the highest paid surgery center in the state or area," depending on the conversation. But in talking with other facilities, [I've heard] they get told the same thing. It's unfortunate because we're paid so much less than hospitals. Sometimes we're unable to do certain cases because the supplies are too costly and reimbursement is too low. In turn, those cases go to the hospital, which is willing to pay tens of thousands of dollars more. If they just paid us a little more, we could have done the case here. Orthopedic cases are the most costly. We see this most often in orthopedics and podiatry.
Q: How does this impact patients?
TH: Patients will honestly have much higher out-of-pocket costs because care is more expensive at other outpatient departments in hospitals. They will likely have a greater financial cash outlay for their deductible and out-of-pocket expenses, depending on their insurance policy.
Q: What has been your strategy in conversations with payers so far?
TH: I try to explain that if they pay us a little more, we can still do the cases. Otherwise, they'll go to a more costly facility, and they'll end up paying quite a bit more for the same care. ASCs typically have lower infection rates and high quality, but it's not typically received well. I haven't gotten very far.
I would like to see the payers be more receptive and realize that ASCs could play a substantial role in cost savings for healthcare. Whether it's for Medicare, Medicaid, commercial insurances, or even the patient, we could save everyone money if they were more open to conversations.