Reimbursement differences between ASCs and HOPDs have been an ongoing challenge for surgery centers, continually making it more difficult for independent ASCs to stay afloat.
Becker's connected with Kristopher Kitz, CEO of Eye Associates of Tucson, Wyatt Surgery Center and Tucson Ambulatory Anesthesia, all in Tucson, Ariz., to discuss a strategy for navigating payer-ASC reimbursement issues.
Editor's note: Response has been lightly edited for length and clarity.
Question: Do you think health systems' increased interest in ASCs will affect the industry?
Kristopher Kitz: The more traditional model for an ambulatory center, at least right now, is to form a joint venture with the health system or a Tenet or USPI, or another large organization whereby you sell 51% to them so that they can do the pair contracting for that surgery center. The problem is, I think you're also seeing more and more surgeons who don't want to give up all that control, but still really want to have sustainable payer rates. As health systems start to be put in a position of losing all this volume from their ORs to surgery centers, and wanting to maintain a part of that revenue by owning an ASC as well. Somehow, the three — the health system, the surgeons and the payers — will all have to come together to realize that the only way to make all three happy is a model whereby surgery centers can be appropriately compensated for the work that they do, not at the low-end of the ASC rate and not the high-end of the hospital rate, but somewhere in the middle that works for everyone.
Because right now, the model is, if you're not owned by a health system, try negotiating independently with payers and see how that goes for you. That's what I'm doing right now. Luckily, the health system owns a portion, but not by any means the majority, so they can't do payer contracting for us. But we're trying to have the best of both worlds, so I hired the hospital's payer contracting consultant to work for us, to try to get a leg up on this world. I think for the model to succeed, those three interests — surgeons, ASCs and health systems — have to find a way to come together.