Opportunities abound in the ambulatory surgery center (ASC) space. Higher-acuity surgical procedures continue to migrate to ASCs, spurred by evolving regulations and the increasing availability of cutting-edge technology (particularly robotics).
But before ASCs can realize the benefits of an expanded case mix, they need to evaluate their readiness to manage it.
Becker’s Healthcare’s 30th Annual Meeting: The Business & Operations of ASCs, took place October 31 through November 2, 2024, in Chicago, bringing together more than 1,000 attendees and 260-plus speakers for to discuss the future of ASCs.
During a panel moderated by ECG partner Matt Kilton, members of ECG’s ASC Strategy and Operations team—Naya Kehayes, Amy Coletti, and Kevin Dowdy—cautioned ASC leaders to be mindful of common pitfalls associated with adding new cases.
Here are three areas ASCs should assess as they look to improve performance amid increasing surgery migration.
- Contracting. Amy Coletti emphasized it more than once: review your contracts. If you’re adding higher-acuity cases and recruiting new surgeons, managed care contracts that you’ve had in place for years—which weren’t set up for those services—will likely need to be updated.
Kevin Dowdy echoed that sentiment and went further, explaining that payer conversations should be a regular occurrence. Don’t let contracts sit on a shelf indefinitely; whenever there’s an opportunity to revisit rates, do it. Routine contact with payers can go a long way toward fostering a positive relationship. - Revenue Cycle.You’ve created new revenue—now you have to go get it. Improving revenue capture is critical for ASCs. With payer benefits constantly changing and patients shouldering more out-of-pocket costs, up-front collection prior to surgery is increasingly important. ASCs without regimented collection processes increasingly struggle to collect after the case is completed.
- Review the ASC chargemaster and determine whether it needs to be adjusted to reflect higher contract allowables or changes in cost.
- Again—keep up with your contracts.
- Work closely with your physician offices to get approvals so reimbursement isn’t denied.
- Communicate expected patient out-of-pocket costs as soon as the case is scheduled, and coordinate collection of patient allowables ahead of surgery.
- Hospital Alignment. Aligning with a health system presents independent ASCs with a range of opportunities and risks. ASC leaders need to fully assess the various impacts that can result from alignment and be sure the hospital they’re aligning with understands them as well. Determine whether the hospital has an appropriately aligned ASC operating strategy and evaluate their managed care reimbursements. A few questions to consider:
- Where does ASC management and operating responsibility reside—with the ASC, the health system, or another entity?
- Does the hospital’s managed care contract team understand patient surgical costs and market rates for ASC services?
- Do the health system contracts with each payer allow the hospital to add new ASCs to existing contracts, or does the payer have the final decision?
- What happens to the ASC if the hospital merges with another entity or gets acquired?
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Published November 13, 2024
