Declining reimbursements in the face of soaring inflation and an increased demand for healthcare is a frustrating, but familiar, scenario for many ASC leaders and physicians.
Those who attempt to negotiate rates often find themselves in stalled and disappointing conversations with little change.
"We as physicians have very little, if any, opportunity to speak with payers. If we are lucky, I get to speak to a 'claims specialist' to argue about why I am not being paid," Ravi Krishnan, MD, an ophthalmologist at The Eye Institute of Corpus Christi (Texas) told Becker's. There is some so-called negotiation of the payment schedule beforehand, but as an owner of a small solo practice, I have very little bargaining power."
Here are three notes for ASC leaders navigating strained negotiations with payers and managing costs as reimbursements decline:
1. Purchase market data: Kristopher Kitz, the CEO of Eye Associates of Tucson and Tuscon Ambulatory Anesthesia, told Becker's that access to market data can give ASC leaders a vital level of transparency going into conversations with payers.
"You can't have one ASC in our region getting paid 50% less than another one, because then they're not competitive, and they can't reinvest, and then it just doesn't work," he said.
2. Bring any health system affiliates to the bargaining table, if possible. Many ASCs have affiliated health systems or are a part of joint venture deals. For these ASCs, bringing any affiliated partners to negotiations could aid their efforts to achieve more favorable reimbursement rates. This has been helpful for Mr. Kitz and his ASC, which is affiliated with a larger health system.
"Right now, we are renegotiating our payer contract because our rates are so low and we added service lines to the center," Mr. Kitz said. "And the only reason why they will speak with us and even entertain materially better rates is because we have a health system affiliation."
3. Financial optimization: Without receiving preferable or sustainable rates, ASCs must evaluate their costs from an operations standpoint. Benita Tapia, RN, administrator and director of nursing at Beverly Hills, Calif.-based 90210 Surgery Center, shared with Becker's strategies for maintaining financial stability in this challenging dynamic. They included conducting regular cost analyses to identify areas where expenses can be reduced without compromising the quality of care. She also suggests ensuring that revenue cycles are optimized to ensure timely and accurate billing, reduce denials and improve collection.