Donna Smith, president of the Alabama Association of Ambulatory Surgery Centers and administrator of The Surgery Center in Oxford, Ala., discusses five trends affecting the future of ASCs in her state.
1. Unemployment and economic downturn have caused a rise in payment plans. While Alabama is neck-and-neck with the national unemployment rate as a whole, Ms. Smith says rural areas of the state have been affected at a rate higher than the national average. As patients struggle to pay their medical bills, Alabama ASCs are forced to consider options they might not have accepted in the past, such as long-term payment plans. "ASCs have to do more to compensate for the patient not having enough out-of-pocket money," Ms. Smith says. "They have to make sure they offer options that allow the patient to pay over time."
She says the problem is especially serious for younger patients for whom "elective" surgery is more necessary. "If a child needs adenoid removal, that's not really an elective surgery for a parent," she says. "We're working with those patients to make surgery affordable for them."
2. ASCs are using medical distributors for more products than in the past. Ms. Smith says Alabama ASCs have responded to economic downturn and tighter budgets by going through distributors to achieve savings on janitorial and office supplies as well as medical supplies. "Those are supplies we [traditionally] didn't purchase with a medical distributor," she says. She says working with a distributor for those supplies can save ASCs money at a time when keeping supply costs low is essential for a center's financial stability.
3. Expansion of Medicaid eligibility for children might hurt ASC reimbursement rates. Children in Alabama who are ineligible for Medicaid but cannot afford private health insurance are covered under the ALL Kids program, a health insurance program for children under the age of 19. "It's been a phenomenal program because it reimburses at Blue Cross rates," she says. "But we understand that because of Medicaid eligibility requirements being expanded, some of those kids [that weren't previously covered] will fall under Medicaid and increase our Medicaid numbers." Since Medicaid reimbursement rates are significantly lower than the current ALL Kids/Blue Cross reimbursement rates, she predicts ASCs will be forced to reject Medicaid cases for children.
"There's not really anything we can do [about the eligibility change," she says. "It's just part of healthcare reform. So we're going to wait and see what the impact is."
4. Many Alabama insurance carriers do not reimburse for implants. According to Ms. Smith, a good portion of insurance carriers in Alabama do not reimburse for implants, a decision that negatively impacts ASCs performing a high number of orthopedic cases. "Because the cost of the implants is so high, the cost is significantly higher than what we get reimbursed for," she says. "It means that either those cases have to be done at a huge loss, or they have to be sent to the hospital."
Many Alabama ASCs are affected by the lack of implant reimbursements because the majority of the state's 32 licensed ASCs are multi-specialty facilities, Ms. Smith says.
5. Alabama Association is working with other states to share advice and tackle challenges. The Alabama Association boasts a membership rate of 80 percent of freestanding ASCs in the state, and Ms. Smith says the association is rapidly getting involved with fundraising and education on a national level. The association has worked to bring national speakers to the association and hold workshops on various topics, as well as hold an annual ASC conference that brings together ASCs from Alabama, Mississippi, Louisiana and northern Florida. "This will be our fourth year [doing the annual meeting], and it has been great," she says. "We have a lot of similarities — we're all CON states, we have large facilities and a small number of them. It's been great to combine those groups for an annual meeting every summer."
Learn more about the Alabama Association of Ambulatory Surgery Centers.
1. Unemployment and economic downturn have caused a rise in payment plans. While Alabama is neck-and-neck with the national unemployment rate as a whole, Ms. Smith says rural areas of the state have been affected at a rate higher than the national average. As patients struggle to pay their medical bills, Alabama ASCs are forced to consider options they might not have accepted in the past, such as long-term payment plans. "ASCs have to do more to compensate for the patient not having enough out-of-pocket money," Ms. Smith says. "They have to make sure they offer options that allow the patient to pay over time."
She says the problem is especially serious for younger patients for whom "elective" surgery is more necessary. "If a child needs adenoid removal, that's not really an elective surgery for a parent," she says. "We're working with those patients to make surgery affordable for them."
2. ASCs are using medical distributors for more products than in the past. Ms. Smith says Alabama ASCs have responded to economic downturn and tighter budgets by going through distributors to achieve savings on janitorial and office supplies as well as medical supplies. "Those are supplies we [traditionally] didn't purchase with a medical distributor," she says. She says working with a distributor for those supplies can save ASCs money at a time when keeping supply costs low is essential for a center's financial stability.
3. Expansion of Medicaid eligibility for children might hurt ASC reimbursement rates. Children in Alabama who are ineligible for Medicaid but cannot afford private health insurance are covered under the ALL Kids program, a health insurance program for children under the age of 19. "It's been a phenomenal program because it reimburses at Blue Cross rates," she says. "But we understand that because of Medicaid eligibility requirements being expanded, some of those kids [that weren't previously covered] will fall under Medicaid and increase our Medicaid numbers." Since Medicaid reimbursement rates are significantly lower than the current ALL Kids/Blue Cross reimbursement rates, she predicts ASCs will be forced to reject Medicaid cases for children.
"There's not really anything we can do [about the eligibility change," she says. "It's just part of healthcare reform. So we're going to wait and see what the impact is."
4. Many Alabama insurance carriers do not reimburse for implants. According to Ms. Smith, a good portion of insurance carriers in Alabama do not reimburse for implants, a decision that negatively impacts ASCs performing a high number of orthopedic cases. "Because the cost of the implants is so high, the cost is significantly higher than what we get reimbursed for," she says. "It means that either those cases have to be done at a huge loss, or they have to be sent to the hospital."
Many Alabama ASCs are affected by the lack of implant reimbursements because the majority of the state's 32 licensed ASCs are multi-specialty facilities, Ms. Smith says.
5. Alabama Association is working with other states to share advice and tackle challenges. The Alabama Association boasts a membership rate of 80 percent of freestanding ASCs in the state, and Ms. Smith says the association is rapidly getting involved with fundraising and education on a national level. The association has worked to bring national speakers to the association and hold workshops on various topics, as well as hold an annual ASC conference that brings together ASCs from Alabama, Mississippi, Louisiana and northern Florida. "This will be our fourth year [doing the annual meeting], and it has been great," she says. "We have a lot of similarities — we're all CON states, we have large facilities and a small number of them. It's been great to combine those groups for an annual meeting every summer."
Learn more about the Alabama Association of Ambulatory Surgery Centers.