At the 12th Annual Spine, Orthopedic and Pain Management-Driven Conference + Future of Spine in Chicago on June 13, speakers from Eveia Health Consulting & Management discussed payer negotiations for high-cost implants.
Amy Coletti, manager at Eveia, said to be sure to look at potential plans for the future when discussing contracts with payers. "If you're going to approach a payer to renegotiate your contract, you need to look at what you're doing now and what you're planning on doing in the next three or six months," Ms. Coletti said. "A payer doesn't want to have a provider come and reopen a contract six months later. That's administratively challenging."
Additionally, Ms. Coletti said to be aware of high variation between contracts, no matter how similar facilities and arrangements may be. "If you've seen one contract, you've only really seen one contract."
When discussing these contracts, Matt Kilton, Principal & COO at Eveia, suggested that providers share with payers as much data as possible when submitting proposals for reimbursement. He confirmed that implant costs, case costs and capital replacement expenditures are all critical to negotiating a good contract with payers. "It’s important to recognize your utilization, both current utilization and costs associated with that," Mr. Kilton said. "Routinely it’s becoming more and more important to educate Payers with center specific data that support reimbursement proposals."
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Amy Coletti, manager at Eveia, said to be sure to look at potential plans for the future when discussing contracts with payers. "If you're going to approach a payer to renegotiate your contract, you need to look at what you're doing now and what you're planning on doing in the next three or six months," Ms. Coletti said. "A payer doesn't want to have a provider come and reopen a contract six months later. That's administratively challenging."
Additionally, Ms. Coletti said to be aware of high variation between contracts, no matter how similar facilities and arrangements may be. "If you've seen one contract, you've only really seen one contract."
When discussing these contracts, Matt Kilton, Principal & COO at Eveia, suggested that providers share with payers as much data as possible when submitting proposals for reimbursement. He confirmed that implant costs, case costs and capital replacement expenditures are all critical to negotiating a good contract with payers. "It’s important to recognize your utilization, both current utilization and costs associated with that," Mr. Kilton said. "Routinely it’s becoming more and more important to educate Payers with center specific data that support reimbursement proposals."
More articles on ASC issues:
10 things to know about ophthalmology
8 critical healthcare law issues for ASCs
Supply management optimization: ASC challenges & solutions