Three gastroenterology or endoscopy center leaders joined Becker's to discuss what's missing in conversations with payers:
Advantages of ASCs
Emphasizing the advantages of ASCs could give centers more leverage in these payer conversations, Shakeel Ahmed, MD, gastroenterologist and CEO of St. Louis-based Atlas Surgical Group, said.
"Focusing on the advantages of ASCs (decreased infection rates, more rapid recovery and patient satisfaction) only strengthens their position," he said. "It seems obvious, but it is critical to articulate how ASCs have been proven to save money long term, in a very high-volume way. Developing a partnership where both sides are committed to the common mission of quality care at moderate cost is likely to improve negotiations and result in more favorable reimbursement terms."
Lara Kelly, CEO of Louisville, Colo.-based Gastroenterology of the Rockies, added that "highlighting the long-term benefits of ASCs, such as reduced hospital readmissions and lower overall healthcare costs, can shift the focus from short-term expenses to long-term value and cost savings."
Metrics
ASCs should also come into payer negotiations with metrics to back up the benefits, Ms. Kelly added.
"Providing detailed data on patient outcomes, cost efficiencies and procedural volumes can help demonstrate the value and effectiveness of ASC services," she said. "This data supports stronger arguments for fair reimbursement rates and value-based agreements."
Additionally, emphasizing patient satisfaction and care quality metrics can "strengthen the case for higher reimbursement rates," since payers are hyper-focused on positive patient outcomes," she said
Flexible contracting models
Gastroenterology ASCs and endoscopy centers also can gain the upperhand in payer negoriations by being flexible with their contracting models.
"Proposing innovative contracting models, such as bundled payments or shared savings arrangements, can align incentives between ASCs and payers," Ms. Kelly said. "These models can address the financial challenges both parties face and encourage collaborative solutions."
Dr. Ahmed echoed these sentiments: "Conversations should go further to address cutting-edge payment models like bundled or shared savings, designed to better align payer incentives," he said.
Cost transparency
Cost transparency is another way to gain leverage, especially with the cost-saving potential of ASCs.
"Openly discussing the true costs of procedures and operations helps build trust and clarity with payers," Ms. Kelly said. "It can also highlight areas where payers might be underestimating costs or misunderstanding the financial pressures faced by ASCs."
ASCs also need to be clear about the analysis of all costs, not just the supplies used during a procedure.
"Maintaining facilities and compliance is a huge part of what we do and why ASCs are better than hospitals," Helen Lowenwirth, administrator of New York City-based East Side Endoscopy, said. "Compensation for all professions (registered nurses, technicians and administrative staff) has increased significantly post-COVID-19. Maintaining a safe environment with emergency supplies, backup systems [and] complying with life safety codes and staff education needs to be part of the conversation."