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FEATURE


include that cost in the fee or bill the patient for them after. In most of our centers, we include implants in the fee we quote to patients because we can easily determine those costs upfront.” Once you know your costs, you can


more effectively set your fees to ensure a reasonable margin for the facility and an affordable price for the patient, she says. “Fees are typically set using either the center’s average commercial reimbursement or a factor of the facil- ity’s Medicare rates, perhaps 150 per- cent to 180 percent.” Keeping costs low is vital to the success of Northern California Sur- gery Center’s program, Harmon says. “Our markup on implants is negligible for cash-pay patients. We mark them up just enough to cover tax and ship- ping. We make a margin off of the pro- cedure, and even that we keep as low as possible.” The ASC also offers payment pro- grams, with one such service provid- ing patients with financing and no interest. “We pay the fee,” Harmon says. “Patients have 18 months to two years to cover their medical bill with- out paying any interest.”


McMahan advises using pay- ment programs sparingly. “The lon- ger patients have to pay, the more likely it is that full payment will not be received. Our cash-pay payment poli- cies typically require patients to pay in full prior to or on the day of surgery. If people want to take advantage of cash-pay discounts, it is reasonable to expect them to pay up front.” ASCs would be wise to develop documentation that details exactly how their cash-pay option works, McMa- han says. “Ensure you underscore that the cost quoted is an estimated bill. Patients need to know that if a physi- cian, during surgery, identifies a need for a different procedure or uses other implants, they may receive a bill for those additional services. We highlight that information on our forms.”


thing you want to put together in a day. Research how other ASCs run their cash-pay program to get ideas for your own. Take the time to involve all your staff and gather their input, especially those on the supply side. You need a clear understanding of what you are spending on your procedures if you want your program to succeed.”


If your facility does not offer a cash-pay option, surgical patients may opt to obtain care from a facility that does.”


— Kelli McMahan, RN, CASC Pinnacle III


Include a clause in your documenta- tion that states services provided were based on a cash pay arrangement and ensure patients understand these charges will not be billed to insurance, she adds. “We state on our forms that they will not receive a claim form to send to insur- ance now or in the future. Patients may request a claim form later if they become hurt or have an accident the same year of their procedure. They suddenly find themselves in a situation where they need those dollars previously spent applied to their deductible. That cannot occur for many reasons, so cover your bases by being clear in your documenta- tion and corresponding discussions with your patients ahead of time.” For ASCs planning to launch a cash-pay program, Pealock advises doing so carefully. “This is not some-


Marketing Opportunities To help build awareness of its cash- pay program, Cedar Orthopaedic Sur- gery Center’s web site, Delcore.org, provides price quotes and discusses the appeal of Cedar City as a destination for care. The ASC also became a mem- ber of the Free Market Medical Associ- ation, FMMA.org, which aims to con- nect buyers of health care services with sellers. “The more you can get your name out there, the more likely you are to get traffic,” Pealock says. “We are also having ongoing discussions with businesses and groups in our commu- nity about our cash-pay program and partnership opportunities.” To attract patients from Canada,


Northwoods Surgery Center ran an ad in a Thunder Bay publication. “It focused primarily on total joint and knee procedures, but also listed other procedures that can be paid for in cash,” McMahan says. “After the ad ran, we were contacted by two other publications interested in running sto- ries on the program. We ended up with some valuable free marketing.” Northern California Surgery Cen-


ter has effectively grown its cash-pay program without any formal marketing plan, Harmon says. “Word-of-mouth has been the best marketing avenue for us. When people hear a facility is will- ing to work with them and offers fair rates, they come to us. Surgeons know that we do the best we can to accom- modate their patients’ needs. That keeps the referrals coming.”


ASC FOCUS OCTOBER 2017 |www.ascfocus.org 17


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