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Use Quality Metrics to Negotiate Contracts Share patient satisfaction ratings, hospital transfer data and other quantifiable measures BY ROBERT KURTZ


F


or payers on the fence about whether to provide your ASC with


a new or improved managed care con- tract, sharing quality data could be what you need to swing the tide in your favor. “For new and/or advanced proce- dure types, it is always good to have data supporting the fact that your ASC does a significant number of those types of cases and that the outcomes are favorable,” says Rita Reyes-Wil- liamson, senior director of managed care for Surgery Partners in Brent- wood, Tennessee. “We always use some level of quality metrics in con- tract negotiations to make the case for payer leadership to consider initiatives that are focused on case redirection to our ASCs.”


Nicole Carrington, business direc- tor for Delaware Outpatient Center for Surgery in Newark, Delaware, says that her ASC has benefitted from the ability to demonstrate its high level of care. In one instance, the ASC shared its 98 percent patient satisfaction rat- ing with a payer representative, and the rep was impressed. “We were able to secure the contract we wanted,” she says. “While we cannot be sure that our satisfaction rate was a driving factor, it definitely helped us make a stronger argument.” The ASC is hoping another qual- ity metric will help it secure a bundled contract for total joints, Carrington says. The payer is trying to include a readmission clause in all its bundled contracts. The clause states that if a patient is admitted to a hospital within 90 days of the date of service, the ASC would be responsible for the cost of that readmission. “We cannot afford to agree to this clause, so we are sharing


We always use some level of quality metrics in contract negotiations to make the case for payer leadership to consider initiatives that are focused on case redirection to our ASCs.”


— Rita Reyes-Williamson Surgery Partners


our hospital transfer rate data with this payer,” she says. “This helps make the case that if a patient of ours is admitted to a hospital, it is likely because of an underlying comorbidity or other issue out of the control of our ASC.” Metrics that can be quantified are


likely to be the most effective dur- ing negotiations, Reyes-Williamson


26 ASC FOCUS FEBRUARY 2020 | ascfocus.org


says. “Payer leadership teams are smart. They will determine that fewer readmissions and infections lead to reduced medical cost of care. For this reason, readmission, complication and infection rates are probably the most impactful.”


Pick which payers you want to


share your quality metrics with care- fully, Carrington advises. “Some payer teams know the benefits of an ASC immediately, but not all. Those are the ones that you should provide your data to and educate on the value you pro- vide to patients and payers.” The good news for ASCs, Reyes-


Williamson says, is that payers are increasingly embracing quality metrics to promote certain initiatives, such as site-of-service differentials and select bundled payment programs designed to move high-cost/high-acuity cases to the ASC. “That is a win-win for the patient, from a cost and safety stand- point, and for the payer, from a cost and member satisfaction standpoint, not to mention the ASC upside.” ASCs


will benefit if quality


becomes a more significant factor dur- ing managed care contract negotia- tions, Carrington says. “Reimburse- ment based on quality metrics would be a more efficient and fair way to do business, in my opinion. You should be able to provide your quality data to a payer and request a contract and reim- bursement based off that data rather than less significant factors, such as location or size. As a patient, it would be comforting to know that the provid- ers in your network were selected, at least in part, because they have demon- strated an ability to deliver very safe, efficient care.”


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