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Surgery centers must stay on top of payers to ensure success — 3 ASC leaders share thoughts

While payers continue to drive volume to the outpatient setting, surgery centers can be successful and negotiate proper reimbursement rates.

Rob Landerholm, MD, president and medical director of Eviva; Maggie Summerfelt, administrator at Omaha, Neb.-based Advanced Surgery Center; and Amy Coletti, senior manager at ECG Management Consultants, discussed emerging trends in the ASC industry during an Oct. 24 presentation at the Becker's ASC Review 26th Annual Meeting in Chicago.

While payers continue to move cases to the outpatient space, Ms. Coletti stressed the importance of using data to ensure ASCs are properly reimbursed for the increased caseload.

"Various payers are insisting that certain cases go to the ASC setting if the patient is healthy enough," Ms. Coletti said. "[Payers] are issuing CPTs and case types that can't be done in the hospital unless it's medically necessary. They're forcing those cases to move to the ASC setting, and I think it's important when you're talking to payers that [while] they're driving that volume to the ASC, [you have to ask] are they paying you enough to do those cases?"

Ms. Summerfelt and Advanced Surgery Center began performing total joints in the early 2000s. Now with the potential migration of Medicaid total joint patients to the ASC, she said it would be more important than ever for ASCs to control costs.

"It's easier for me to say yes to a case when I know we're going to be reimbursed for the implants," she said. "We enjoyed the wealth of Medicare not having a number, because once Medicare puts a number on a CPT code, you know your price is going to go down. You need to be careful with insurance groups, especially in orthopedics."

Despite decreasing reimbursement, Dr. Landerholm echoed Ms. Summerfelt, saying ASCs will still be able to thrive in the new reimbursement environment by minding their costs.

"You have to know what your bottom line costs are as you're negotiating with insurance companies," Dr. Landerholm said. "In our business model, we were in network with three payers, but recently we went in network with all payers except for one. … You have to stay on top of your game. Historically, you have to renegotiate your contracts. We have a person dedicated to that in our organization, and we've been successful in carving out our reimbursements."

More articles on surgery centers:
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Stark Law changes in the works & 4 other must-read articles 

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