Here are five tips for managing implants profitably at ASCs.
1. Keep a close inventory of the items that are used the most. These may be low-cost items or could be high-cost items but they are used more frequently than other items, says Regina Robinson, RN, MBA, CMPE, CASC, Director, Peninsula Surgery Center in Newport News, Va. As such, it may be harder to control the inventory because of the rapid turnover. The materials management personnel should be very mindful of these items, since inaccurate tracking might lead to count discrepancies and not having the item for surgery.
Usually the employee in charge of ordering supplies for this area is the one that stocks the shelves, says Ms. Robinson. However, there are times when an item is ordered directly from a company and local reps will make the delivery and offer to stock the item themselves. While this may make the job easy for the employee, it also allows a non-employee in a restricted area. All non-employees should be escorted to the area and supervised when restocking the shelves. Some ASCs elect not to let reps in this area at all.
2. Control and limit interactions between device representatives and physicians. While you can't bar your surgeon from seeing the rep, you can restrict his visits and hope the surgeon learns to choose better, says Larry Teuber, MD, a neurosurgeon, president of Medical Facilities Corp. and physician executive of Black Hills Surgery Center, an 11-OR facility in Rapid City, N.D., with 14 orthopedic and 5-6 spine surgeons. He says administrators should not allow reps to park in the patient, physician or staff lots. "I've had vendors' cars towed out of the doctors' parking lot," Dr. Teuber says. "Their car is put in a flatbed truck and towed past the OR for all to see."
Reps should not be allowed into the physicians' lounge or locker rooms. They must use the staff lockers to change into scrubs. "The more time you put a rep in front of a surgeon, the more opportunities he has," Dr. Teuber says. Representatives that have more time with surgeons can "upsell" their wares. The supply room should also be off-limits to the reps. Representatives have been known to go into the supply room on their visits and put more implants on the shelf as "consignment" items, which are owned by the vendor until they are opened and used. In a facility that intentionally keeps inventory low, reps know that extra implants on the shelf is an incentive to use them.
3. Understand how implants fit into your managed care contract. Ms. Rock says your biller should have a copy of every managed care contract and understand the details of each one. "You need to understand how long you have to submit a claim, how long you have to review an adjudicated claim, what the payment methodology is, why a carrier would reduce multiple procedures and how to appeal a claim that hasn't been paid correctly," she says. Your ASC should use your managed care contract to bill out, post payments and follow up, and you need it in every point of the revenue cycle. For example, by reading your managed care contract carefully, you will avoid taking an orthopedic case with a $2500 implant attached when you have a carrier that doesn't reimburse implants.
This problem can be solved through simple research. Make sure you have your contracts on hand and refer to them frequently. Understanding the ins and outs of your contract can help you save money and make you more aware of which procedures are most profitable to your center.
4. Seek carve-outs when it makes sense. If a procedure is unprofitable due to an extensive supply cost and reimbursement can't be set at a proper level, request that the implants be a separate line item in the contract. Share the cost information for the implants with the payor during negotiations, says Jim Odom of The C/N Group. "Most payors will provide a margin if you prove cost," he says.
5. Use third-party device benefit managers. Blue Cross Blue Shield of Texas uses Access MediQuip to purchase and bill for implants. "It's a tremendous relief because we don't have to worry about these expenses,"says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. However, the ASC must still negotiate discounts with vendors.
1. Keep a close inventory of the items that are used the most. These may be low-cost items or could be high-cost items but they are used more frequently than other items, says Regina Robinson, RN, MBA, CMPE, CASC, Director, Peninsula Surgery Center in Newport News, Va. As such, it may be harder to control the inventory because of the rapid turnover. The materials management personnel should be very mindful of these items, since inaccurate tracking might lead to count discrepancies and not having the item for surgery.
Usually the employee in charge of ordering supplies for this area is the one that stocks the shelves, says Ms. Robinson. However, there are times when an item is ordered directly from a company and local reps will make the delivery and offer to stock the item themselves. While this may make the job easy for the employee, it also allows a non-employee in a restricted area. All non-employees should be escorted to the area and supervised when restocking the shelves. Some ASCs elect not to let reps in this area at all.
2. Control and limit interactions between device representatives and physicians. While you can't bar your surgeon from seeing the rep, you can restrict his visits and hope the surgeon learns to choose better, says Larry Teuber, MD, a neurosurgeon, president of Medical Facilities Corp. and physician executive of Black Hills Surgery Center, an 11-OR facility in Rapid City, N.D., with 14 orthopedic and 5-6 spine surgeons. He says administrators should not allow reps to park in the patient, physician or staff lots. "I've had vendors' cars towed out of the doctors' parking lot," Dr. Teuber says. "Their car is put in a flatbed truck and towed past the OR for all to see."
Reps should not be allowed into the physicians' lounge or locker rooms. They must use the staff lockers to change into scrubs. "The more time you put a rep in front of a surgeon, the more opportunities he has," Dr. Teuber says. Representatives that have more time with surgeons can "upsell" their wares. The supply room should also be off-limits to the reps. Representatives have been known to go into the supply room on their visits and put more implants on the shelf as "consignment" items, which are owned by the vendor until they are opened and used. In a facility that intentionally keeps inventory low, reps know that extra implants on the shelf is an incentive to use them.
3. Understand how implants fit into your managed care contract. Ms. Rock says your biller should have a copy of every managed care contract and understand the details of each one. "You need to understand how long you have to submit a claim, how long you have to review an adjudicated claim, what the payment methodology is, why a carrier would reduce multiple procedures and how to appeal a claim that hasn't been paid correctly," she says. Your ASC should use your managed care contract to bill out, post payments and follow up, and you need it in every point of the revenue cycle. For example, by reading your managed care contract carefully, you will avoid taking an orthopedic case with a $2500 implant attached when you have a carrier that doesn't reimburse implants.
This problem can be solved through simple research. Make sure you have your contracts on hand and refer to them frequently. Understanding the ins and outs of your contract can help you save money and make you more aware of which procedures are most profitable to your center.
4. Seek carve-outs when it makes sense. If a procedure is unprofitable due to an extensive supply cost and reimbursement can't be set at a proper level, request that the implants be a separate line item in the contract. Share the cost information for the implants with the payor during negotiations, says Jim Odom of The C/N Group. "Most payors will provide a margin if you prove cost," he says.
5. Use third-party device benefit managers. Blue Cross Blue Shield of Texas uses Access MediQuip to purchase and bill for implants. "It's a tremendous relief because we don't have to worry about these expenses,"says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. However, the ASC must still negotiate discounts with vendors.