Randy Todorovich, senior vice president for managed care at ASD Management in Pasadena, Calif., discusses his experiences contracting with the California prison system to handle prisoners at a few of ASD's ambulatory surgery centers.
Question: What are the advantages to the ASC in handling prisoners?
Randy Todorovich: Payments to treat California prisoners have dropped but they still are higher than Medicare. The volume is low to moderate. This is definitely never going to be one of your top five payors, but you can cover your overhead and use the contract to attract new surgeons to your facility. A small number of surgeons are comfortable treating prisoners. If they start using your ASC for prisoners, the hope is they will bring other cases there as well.
Q: How does an ASC qualify to treat prisoners?
RT: You have to be near a prison, of course. You have to have a physician on staff who treats patients at the prison and you have to sign a contract for services. In California, some of our centers have contracted directly with the state and, more recently, with a private health plan that is contracted with the state.
Q: How do you negotiate the contract?
RT: It was a real bear when we negotiated with the state. It took a year, due to delays and the state officials' lack of knowledge of this sort of contracting. I had to teach them how APCs work. Negotiations got easier last year, when Health Net, the private plan, took over the state contract. The Health Net people are serious professionals who understand the process, but payments are lower because Health Net took a share of state payments off the top. Generally, prison contracts are fairly straightforward and there is not that much room for negotiation. But there are certain factors that can get you a slightly higher rate, such as having doctors who are well respected by the prison hospital staff.
Q: What kinds of cases are involved?
RT: That depends on a number of factors, such as what the prison needs, what kind of specialists you have and whether you can make money on a particular case. The prison is usually backed up with cases. They would like us to do orthopedics, but it's better to stick with the lower-cost specialties and limit exposure. One of our ASCs currently does GI and podiatry cases for the Vacaville prison in Northern California. In the past, another one of our ASCs did gynecology cases for a women's prison in California.
Q: How do you handle prisoners' visits to the ASC?
RT: Prisoners can be mixed in with other cases or seen separately. Our ASCs have done it both ways. We've had no problems comingling prisoners with other patients. The prisoner comes in through a side door with a couple of armed guards and is in shackles. Other patients might possibly get a glimpse of them, but that's all. It’s a very secure situation and we've never had an issue. One of our ASCs saw prisoners separately, on a Saturday morning. There have to be enough cases to justify opening on a Saturday. Generally, more than two cases can cover your costs for the day.
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