ADVOCACY SPOTLIGHT
Reimbursements: The Biggest Challenge Ohio Association of Ambulatory Surgery Centers Executive Director Randy Leffler encourages ASCs to communicate with their legislators.
How did you became involved in the ASC industry and come to lead the Ohio Asso- ciation of Ambulatory Surgery Centers? LEFFLER: I was fortunate enough to become in- volved in the ASC indus- try thanks to the incredible leaders on the Board of
Trustees of the Ohio Association of Am- bulatory Surgery Centers (OAASC). They entrusted me to tell their story and manage their already very strong organization. My background is in associa- tion management, advocacy and, in fact, government management. I have worked in the US Congress, state leg- islature and a state agency that dealt with a wide range of Medicare, Med- icaid and private insurance issues for senior citizens. That work certainly helped me better understand the chal- lenges that ASCs face with reimburse- ments and health care in general. Prior to joining the OAASC, I
worked with Ohio’s manufacturers’ as- sociation. While that might seem quite different from the ASC world, I believe that manufacturers’ focus on efficien- cy, quality and cost savings is exactly in line with the priorities of the ASC community and has, hopefully, helped us be better advocates in our indus- trial state.
What do you see as the biggest challenge, nationally and in your state, facing the ASC industry currently? LEFFLER: In my mind, there is no doubt about it . . . reimbursements. Obviously, it mostly starts with Medicare where most of public and private insurers base their reimbursements. While increases in regulatory burdens certainly put pressures on most centers, the lack of adequate payments for procedures and
various contractual hoops put the indus- try in a precarious position. In Ohio, we have seen a number of centers close and an even greater num- ber of centers become hospital outpa- tient departments (HOPD). In several smaller communities, the only ASCs in the area have converted to hospital departments solely due to reimburse- ment levels. It adds costs to the system and for patients. That is what makes national advocacy and local outreach so very important.
What trends legislatively are you seeing in Ohio that ASCs in other states should be concerned about? LEFFLER: In Ohio, we have seen a much greater focus from both the legislature and administration regarding inspections and quality for ASCs. Notably, some of the issues related to compounding and potential infection protection issues have led to this scrutiny. Additionally, we have language in
our state budget enforcing an infection prevention program for ASCs and limit- ing the number of years an ASC–hospi- tal transfer agreement can be in effect. All of this is a part of state licensure. In Ohio, abortion clinics, which are non-Medicare certified, are licensed as ASCs. Attempts to limit transfer agreements for ASCs are mainly re- lated to those centers, however, those changes impact all other centers in the state with additional regulations and a more difficult time in obtaining trans- fer agreements.
Your involvement was instrumental in bringing on sponsors for our fed- eral legislation. Could you explain the process of developing strong rela- tionships with elected officials?
LEFFLER: I have always thought it was pretty simple . . . communicate, com- municate, communicate. The value of meeting and communicating with legis- lators and their staff both at the Capitol and in the district can never be overesti- mated. Making those contacts, getting to know the elected officials and staff, and following up on a regular basis is so important. They value respectful ongoing communications about im- portant issues, especially from their constituents and employers in their district. ASCs have a great story to tell, and I have yet to meet a legislator who does not think so.
ASCA and some state associations
have tools to help members communi- cate, yet I always stress that a personal note in your own words or even a tele- phone call makes a much bigger im- pact than a pre-formatted letter. Never feel nervous about contacting
your elected officials and staff; remem- ber they work for you. Finally, at election time, it is impor-
tant to support those who have sup- ported us.
Do you have any advice for members of ASCA who are interested in being more involved in ASC advocacy activities in their home states and on Capitol Hill? LEFFLER: First and foremost, just try it once. I know that it is a financial and time commitment for most ASC lead- ers, but I have yet to have an Ohio leader who did not think it was a valuable use of their time and a rewarding experience. The legislators and staff are very appre- ciative of your commitment to the indus- try in making the trip, and no one tells your story better than you.
ASCA’s Kara Newbury interviewed Randy Leffler. ASC FOCUS NOVEMBER/DECEMBER 2013 17
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