Falling reimbursements and the specter of healthcare reform create an uncertain future for gastroenterology ASCs, says John Poisson, executive vice president & strategic partnerships officer at Physicians Endoscopy in Doylestown, Pa., which operates 20 GI centers across the country. Mr. Poison offers eight tips on how GI centers can prosper on the next five years.
1. Help physicians market new colonoscopy coverage. On Jan. 1, 2011, Medicare begins paying the full cost of screening colonoscopies rather than paying just 80 percent. This is a significant opportunity for ASCs providing this service. About half of the U.S. population has not been screened. ASCs should start helping affiliated physicians plan significant marketing activities to promote screenings in the first quarter of 2011.
2. Joint venture with a strong hospital. Having close bonds with a strong hospital will be essential when accountable care organizations are launched. As the ACO looks for savings, it will turn to member surgery centers as the low-cost alternative to the hospital OR. Also, physicians in the ACO will be a ready-made referral network for ASCs. A surgery center within the ACO would have a leg up on outside centers, which would require carve-out payments.
3. Now is a good time to find more physician partners. Gastroenterologists who have not become partners in ASCs represent a substantial opportunity to increase ASC volume. As their reimbursements continue to decline, these physicians' incentive to share in the ASC facility fee becomes all the more important. This is a good time to reach out to these potential partners and make the case for investing in your ASC.
4. Work more closely with physicians' offices. Closer cooperation with affiliated physicians' offices can boost ASC volume. Front office staff at the ASC should be in daily communication with the front office of each practice of participating physicians. The ASC should track appointment schedules three or four days in advance, so that it can verify insurance and make other preparations for the patient. If there are no-shows at the ASC, the ASC schedule can be moved up and the practice can direct patients to come in earlier.
5. Make staffing as flexible as possible. Since staffing is the ASC's largest single expense item, it is important to have exactly the right staffing size. So in addition to core full-time staff and permanent part-time staff, assemble per-diem staff who can be bought in when volume is unexpectedly high. Per diems should be recruited into separate pools, such as nurses and surgical technicians, and need upfront training in specific policies and procedures of the ASC.
6. Have quality metrics in place for new payment systems. In the long run, CMS is likely to move from a fee-for-service system to performance-based reimbursements. To prepare for this, ASCs should implement relevant quality metrics now.
7. Make sure staff is patient-friendly. Patients' perceptions of the ASC are expected to become more important, and 80 percent of ASC patients' comments on surveys are about staff. Staff members have to have the right attitude or they should be replaced.
8. Continue to focus on the business fundamentals. Make sure your ASC is operating efficiently and is collecting on claims, because reimbursements are expected to decline. As more people are covered under Medicaid and Medicare, the average payment per patient is likely to fall because CMS tends to have a zero-based approach – as volume rises, it won’t allow overall spending to go up.
Learn more about Physicians Endoscopy.
Read more insight and guidance GI ASCs:
- 5 Quick Guidelines to Improve Turnover Time Between Colonoscopies
- How the Propofol Shortage May Impact GI ASCs
- 3 Ways to Help Keep Gastroenterology in ASCs Profitable and Efficient
1. Help physicians market new colonoscopy coverage. On Jan. 1, 2011, Medicare begins paying the full cost of screening colonoscopies rather than paying just 80 percent. This is a significant opportunity for ASCs providing this service. About half of the U.S. population has not been screened. ASCs should start helping affiliated physicians plan significant marketing activities to promote screenings in the first quarter of 2011.
2. Joint venture with a strong hospital. Having close bonds with a strong hospital will be essential when accountable care organizations are launched. As the ACO looks for savings, it will turn to member surgery centers as the low-cost alternative to the hospital OR. Also, physicians in the ACO will be a ready-made referral network for ASCs. A surgery center within the ACO would have a leg up on outside centers, which would require carve-out payments.
3. Now is a good time to find more physician partners. Gastroenterologists who have not become partners in ASCs represent a substantial opportunity to increase ASC volume. As their reimbursements continue to decline, these physicians' incentive to share in the ASC facility fee becomes all the more important. This is a good time to reach out to these potential partners and make the case for investing in your ASC.
4. Work more closely with physicians' offices. Closer cooperation with affiliated physicians' offices can boost ASC volume. Front office staff at the ASC should be in daily communication with the front office of each practice of participating physicians. The ASC should track appointment schedules three or four days in advance, so that it can verify insurance and make other preparations for the patient. If there are no-shows at the ASC, the ASC schedule can be moved up and the practice can direct patients to come in earlier.
5. Make staffing as flexible as possible. Since staffing is the ASC's largest single expense item, it is important to have exactly the right staffing size. So in addition to core full-time staff and permanent part-time staff, assemble per-diem staff who can be bought in when volume is unexpectedly high. Per diems should be recruited into separate pools, such as nurses and surgical technicians, and need upfront training in specific policies and procedures of the ASC.
6. Have quality metrics in place for new payment systems. In the long run, CMS is likely to move from a fee-for-service system to performance-based reimbursements. To prepare for this, ASCs should implement relevant quality metrics now.
7. Make sure staff is patient-friendly. Patients' perceptions of the ASC are expected to become more important, and 80 percent of ASC patients' comments on surveys are about staff. Staff members have to have the right attitude or they should be replaced.
8. Continue to focus on the business fundamentals. Make sure your ASC is operating efficiently and is collecting on claims, because reimbursements are expected to decline. As more people are covered under Medicaid and Medicare, the average payment per patient is likely to fall because CMS tends to have a zero-based approach – as volume rises, it won’t allow overall spending to go up.
Learn more about Physicians Endoscopy.
Read more insight and guidance GI ASCs:
- 5 Quick Guidelines to Improve Turnover Time Between Colonoscopies
- How the Propofol Shortage May Impact GI ASCs
- 3 Ways to Help Keep Gastroenterology in ASCs Profitable and Efficient