There is no shortage advice and avenues to take in healthcare, but sorting out the advantageous steps from the tactical errors can be tricky. Here are three solid strategies for ASC leaders to invest in and three missteps to avoid this year.
Winning strategies
1. Considering transparency. Demand for price transparency is ramping up as consumer financial responsibility grows, and the healthcare industry is beginning to respond to the demand. Some states have legislation mandating prices be posted, while some facilities are taking the initiative on their own. In any case, hiding from price transparency is becoming less and less of an option.
Proactively taking on price transparency presents ASCs an opportunity to demonstrate value. Additionally, ASCs can consider introducing an element of transparency into quality issues. Patients are increasingly shopping for care, and readily available quality data coupled with pricing is an appealing package.
2. Focusing on quality and value. ASCs know their centers provide high-quality, low-cost care, but it is no longer enough to just know: value has to be quantified and demonstrated. "Establish benchmarks and quality measures," says John Newman, general counsel and senior vice president with Constitution Surgery Centers. "Understanding and reporting the quality dynamic becomes important when contracting with employers and payers. You want to show your center is raising the bar."
3. Analyzing OON strategy. The viability of out-of-network reimbursement in the ASC environment is still hotly debated. Given the wide variance in markets across the country, there is no one answer to whether OON is still an option. Rather than outright dismissing or stubbornly clinging to OON, evaluate your ASC's position in relation to OON contracts and understand the issues associated with this strategy. "A lot of facilities are finding the compliance burden to be a headache," says Mr. Newman. Be aware payers have an increasing tendency to turn to litigation for OON matters. Additionally, OON stance can affect an ASC's future prospects. If a hospital partner is an appealing option, OON volume will affect an ASC's ability to forge such an alliance.
Mistakes to avoid
1. Taking on contracting alone. Managed care contracting is a critical ASC function that can be underestimated. Administrators and the business office team may try to keep the entire process in-house, but more often than not the task becomes too much. "If people try to be penny-wise and pound-foolish by trying to contract on their own without sophisticated expertise, they will get burned and leave money on the table," says Mr. Newman.
While a third-party can effectively handle managed care contracting, the selection process of an outside consultant should be carefully considered. "Some ASC [leaders] look to go out and quickly contract with a third party," he says. "I would be very reticent to look at some of these silver bullet fixes offered by advisors that don't have a good grounding in the industry. This can lead to bad contracts and even anti-trust exposure." Managed care contracting is a fulltime job that requires expertise in the ASC industry. Do your homework before entrusting the process to an outside party.
2. Avoiding IT investment. Surgery centers have tight budgets, but thriving in healthcare without IT is becoming impractical. The need to gather, report and pull meaningful conclusions from cost and quality data is growing; this can only be accomplished with a solid IT system. "The data in many instances is there, you just need the business intelligence to define the measures and populate your reports," says Mr. Newman. Some centers are experimenting with developing proprietary systems, while others turn to vendors.
3. Allowing disorganization in the leadership ranks. It can be easy to slip into the daily routine at an ASC without considering the long-term vision for the center. Leadership should be clearly defined and on the same page when it comes to the facility's future. "Unruly democracies don't fare well," says Mr. Newman. Take the time to assign leadership roles and form a cohesive team.
Strong physician leadership and governance will constantly seek opportunities to grow a center, whether through new physician recruitment or strategic partnerships. "Develop your own plan. Those are the successful facilities, the ones that win," says Mr. Newman.