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FEATURE


cases are only 5 percent of its volume, Daneshvar says. To further compen- sate for the losses incurred on its Med- icaid patients, the center also is trying to bring personal injury (PI)/workers’ comp patients. Bejarano says that ASCs in low- income areas have a much thinner mar- gin of error than ASCs in other areas as far as finances are concerned. “When you open an ASC that is heavily reliant on Medicaid, you can be waiting for 18–24 months to get paid. That is an enormously slow time and very pain- ful because it is as if you are treating patients for free for the first two years,” he says. To put that figure into perspec- tive, he explains that out-of-network pays immediately but could take up to 90 days. Medicare pays within 5–6 months. “Medicaid is easily the slow- est,” he says. “If you overspend on construction, staff or rent, you may be out of business. You also are not subsi- dized by tax payers. So you need to be very precise with your calculations.” Frontier has centers in which 50 per- cent of the volume is Medicaid and other centers in which 70–80 percent of the volume is Medicaid, he adds. The other challenge is patient interactions, Bejarano says. “Lower- income areas, typically, have a heavy immigrant population, lower level of education and lower IT accessibility,” he explains. “They don’t speak Eng- lish, don’t use computers or sometimes even phones. So it is difficult to com- municate with the patients.” Daneshvar’s ASC is in an area that is 80 percent Hispanic. “Only 25 per- cent of our patients in the Bronx use texts,” he says. “We did a survey and found that 85 percent of our patients prefer a phone call and a live per- son instead of getting texts. It is their culture.” About 75–80 percent of his patients have phones. “The ones that don’t have phones—maybe the older generation—still live with someone who has a phone.”


The lower-income populations are


generally less informed when it comes to wellness and health education, Weissbluth says. “No one speaks Eng- lish, so there is a problem in prepping patients,” he says. “Many patients don’t understand how important it is to get screened and have procedures. Fifty percent of the patients I book are no-shows, but I go after them to ensure


they have their health care needs met. I take more time with each patient. It is harder; it is a challenge, and I’ve been doing this for 30 years but I con- tinue to do it because I’m committed to ensuring that patients in this neigh- borhood have access to high-quality health care. I make myself available but it is not easy, and it is getting even more difficult.”


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