DOING BUSINESS


and any implants. This information will allow you to calculate the payer’s coverage for the procedure versus the patient’s responsibility and determine how discounting might be applied for multiple procedures. For out-of-network payers, deter-


mine a fair allowable amount on which to base the allowable amount calculation, typically based on pay- ment history. If that patient has or is near achieving their annual out-of- pocket maximum, you also will need to take that into consideration. Finally, consider whether the payer has designated your ASC within a tiered status and whether the patient is covered by a self-funded employer plan, both of which could affect facil- ity reimbursement.


Determining an accurate quote is critical in today’s environment of high-deductible plans, self-funded plans, tiered networks, patients who defer treatment for financial reasons, and the high cost of unused operating room time.


Engaging Surgeons and Anesthesiologists A key to success is viewing the ASC as part of an integrated provider sys- tem rather than a single site of ser- vice unaligned with its surgeons and anesthesiologists.


Jay Montague, chief financial offi-


cer of The Surgery Center of Hunts- ville in Huntsville, Alabama, has encouraged his surgeons’ office staff to reach out to his ASC’s financial team to discuss financial counseling while the patient is in their office. “I want our staff to take the lead on educating patients regarding the different types of charges the patient may face along with the different rules that may apply from differ- ent providers,” Montague says. “The electronic presentation of the patient


estimate is helping, and any time we save because of automation, we want our team investing in more personal contact with the patients who need it.” He says most affiliated practices are on board with sharing responsibility for educating patients. Bill Hazen, administrator of the


Surgery Center at Pelham in Greer, South Carolina, is going a step fur- ther. He has engaged with surgeon groups and anesthesiologists to share their pricing, so the ASC can present patients with an accurate quote. “We are also working with our payers to align them with our pro- cess,” Hazen says. The ASC is com- bining this information, which will be available on the facility’s web- site and by calling its business office, and supporting the program with a regional marketing push. “We are still working out the details, but I am confident that we will be able to increase case volume while saving patients and payers significant dol- lars,” he adds.


According to Instamed’s 2017


Trends in Healthcare Payments Annual Report, 72 percent of patients are confused by their explanation of benefits while 65 percent would con- sider changing providers for a better financial experience. Whether you are presenting the information electroni- cally, on paper or by phone, you need to ensure that you do not make any assumptions that patients understand their current coverage, the differ- ence between various providers and common terminology used in ASCs. Investing the time to clearly pres- ent and explain the information is in everyone’s best interests and a good business practice.


Tracking and Improvement My experience working with pro- vider organizations has shown me


that any process improvement initia- tive must have clear objectives, exec- utive and board sponsorship, buy-in from staff, a means of tracking activ- ities and a feedback process for mea- suring results. If we apply these to an ASC quoting process, the following would make worthwhile goals: ■■


All prospective patients, regardless of insurance, will be provided with cost information in an understand- able format, in advance of schedul- ing or treatment.


■■


Engage affiliated provider organi- zations in this process, hopefully finding champions willing to sup- port objectives. Share information with them proactively and retroac- tively.


■■


Establish a system of tracking the quotes produced and communica- tions with patients.


■■


Measure improvements in financial or patient loyalty metrics and anec- dotal feedback and stories.


■■


Meet periodically to review results and improve processes as well as recognize and celebrate successes.


The Payoff Through the development of a quot- ing program, ASCs can take a lead- ership role in their local markets by establishing cost transparency while providing patients with a bet- ter financial experience. This could result in improved patient and sur- geon loyalty, increased case volume, improved financial results and com- pliance with consumer protection laws. Change presents opportunity, and higher patient financial respon- sibility is likely here to stay. ASCs need to adapt accordingly.


Scott Palmer is chief executive officer for Clariti Health in Branford, Connecticut. Write him at scott.palmer@clariti-health.com.


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