Bundled payments. Increased co-pays and deductibles. The entire healthcare reimbursement landscape is drastically transforming into a value-based, consumer-oriented environment. So how do ambulatory surgery centers (ASCs) fit into this new healthcare delivery model?

Ambulatory Surgery Centers

Ambulatory centers are compatible with value-based care as they are convenient and affordable.

As long as outpatient surgery clinics employ effective strategies to manage revenue cycle; acquire ideal payer contracts; and meet the rising challenges in the industry – ambulatory surgery centers will thrive nicely in a value-based payment model, according to a recent article in Becker’s ASC Review.

The industry is shifting to consumerism and value-based payments, and surgery centers must keep pace with overall healthcare changes as well as trends specific to the outpatient landscape. – Becker’s ASC Review

Patient Preference Directs Hospital Spending Towards ASCs

Outpatient surgery centers, ambulatory clinics, and other outpatient facilities provide patient a cost-effective and convenient care delivery model. It may come as no surprise that in this era in which value-based care is priority, hospitals and healthcare systems are shifting more of their capital spending to the development of outpatient facilities, according to a recent article in Modern Healthcare.

The article cites examples of organizations that have cut back on hospital spending, but shifted their focus towards outpatient facilities: “Finishing work on big projects in Detroit, El Paso and San Antonio, Tenet Healthcare Corp. is about to throttle back capital spending for hospitals to the tune of $150 million. That doesn’t mean the nation’s third-largest investor-owned hospital company is done spending on healthcare facilities though. In fact, it’s just the opposite on the ambulatory side. Tenet plans to open 15 free-standing emergency departments or micro-hospitals over the next 18 to 24 months, as well as add urgent-care centers in its hub markets.”

Because the fee-for-service medicine model is going away, and reimbursement based on value is the new system, hospitals must provide community access points for convenient and cost-effective care. In addition to the construction of more ambulatory centers, hospitals must also invest in the latest information technology.

Where will these new clinics emerge? The Wall Street Journal reports that many hospitals that are interested in creating more outpatient access are looking at vacated stores within shopping malls. One such example the Dana-Farber Institute that recently leased a massive two-floors within the Chestnut Hill Atrium Mall. The expansive 140,000-square-foot area will be used for supportive services for cancer patients, exams, and infusions.

Ambulatory Surgery Centers Implement Innovative RCM Technology

Outpatient clinics actually have more work on their hands when it comes to effective revenue cycle management (RCM), because they must keep pace with the overall trends in the industry, as well as keep up with the outpatient specifics implications. The director of payer and reimbursement strategy for Cardinal Health, Marilyn Denegre-Rumbin, stated during a recent webinar (view webinar video here, view webinar slides here):

“Today, changes in the healthcare and reimbursement landscape are creating new opportunities for ASCs to improve financial performance, while supporting safety and quality of patient care.”

Ms. Denegre-Rumbin offered the following four considerations for surgery centers to follow in order to help maximize their reimbursement:

  1. Providers and outpatient surgery centers need to focus on improving in terms of operational and financial perspectives. The idea here is to ensure that the organization achieves set scores to avoid penalties and lower reimbursement rates.
  2. Outpatient surgery centers need to consider participation in value-based payment models, such as bundled pricing, pay-for-performance, and shared savings.
  3. Attention needs to be paid to the commercial payers, as they make up a significant percentage of ASC’s payer mix.
  4. Because of the shared-risk arrangements between surgery centers and payers, meaningful conversations need to take place between the two regarding contracts.

As the market continues to change bringing growth to the ASC sector, The SSI Group remains committed to helping ambulatory surgery centers with our Medibis solution, designed to identify and dive into your most pressing operational issues via an expansive suite of intuitive analytics, reports and dashboards.