AS I SEE IT
provider of outpatient surgery, and sig- nificant cost savings can be achieved by moving cases from acute-care hospitals to ASCs. Most managed care companies will be anxious to hear ideas to do this.
3 Consumer-Driven Health Plans
The Health Savings Account (HSA) is rapidly becoming one of the most common health insurance options for employees. The main characteristic of the HSA plan is a drastically higher deductible than the preferred provider organization (PPO) or health main- tenance organization (HMO), often $3,000 or more. While still considered “insured” and falling under an ASC’s contract with the managed care orga- nization, the ASC’s entire fee will be “self pay” if the patient has not met his or her deductible.
Opportunity: Members enrolled in HSAs must have an HSA account that allows them to save money tax free to pay for their out-of-pocket costs, and many employers contribute cash into these accounts. ASC patients can obtain financing for their surgery (e.g., health care credit cards) and pay down their debt with deposits made into their HSA accounts throughout the year. Also, when possible, time the submis- sion of your claim, since the first claim filed will be applied to the patient’s deductible, and those who file after the deductible is met will get paid directly by the insurer.
Drug shortages and the unavail- ability of fluids log-jammed health care in 2014, and there is every rea- son to expect these types of problems to continue this year. Some facilities had to cancel cases until supplies were replenished, and many had to adopt new procedures to utilize these scarce resources more efficiently.
Opportunity: Stay informed. ASCA provides important news bulletins
relating to shortages and vital industry intelligence, as well as safe, creative techniques that can help your supply inventory go farther. Maintaining a strong relationship with your suppliers can keep you abreast of supply lines and alternative procurement sources.
5 Safety and Quality Patient acuity in ASCs is increasing
rapidly, as more procedures previously “inpatient only” are now routinely performed in surgery centers, and more of our patients have comorbid conditions. Even so, ASCs are still arguably the safest setting for outpatient surgery, due to the myriad of processes and procedures that help ensure patient safety and quality of care. When these procedures are not followed, patient safety is compromised.
Opportunity: ASC leaders need to ensure personnel are empowered to stop a process if it is unsafe. Govern- ing boards and medical executive com- mittees should take their responsibilities seriously, carefully reviewing policies and procedures, credentialing, privileg- ing and peer review. Surgery center per- sonnel should be knowledgeable of cre- dentialing and privileging requirements and authorized to stop a practitioner from practicing without specific privileges or without accurate patient consent.
6 New Service Lines We are at the cusp of the next big
wave in ambulatory surgery. Amaz- ing advances in surgical technique, anesthesia and pain control are rap- idly expanding the types of proce-
dures that can be done safely in an ASC, many of which most of us would never have dreamed possible. Proce- dures like spine surgeries, total knee and hip replacements, vascular surgery and pacemakers are now routinely per- formed in the outpatient setting.
Opportunity: Start talking to your sur- geons now about developments in their specialty. Involve your anesthesia pro- viders to ensure that advances in pain control are considered. Attend ASCA 2015 and network with other ASCs performing innovative procedures.
We live in an exciting age of lasers, robots, stem cells and magical drugs that would have been labeled “science fiction” not so long ago. Some of these new technologies provide wonderful clinical benefits, while others are no more than an expensive toy, with no demonstrable link to improvements in patient outcomes. Even with the most effective new technology, getting addi- tional reimbursement to offset the added costs incurred might seem impossible.
7 New Technologies
Opportunity: While additional reim- bursement for new technologies might be difficult to obtain, when you find something that clearly improves patient outcomes and care in your ASC, you should still try. Try to carve out procedures that require expensive technology. At a minimum, maintain a record of new technologies and cost increases to help you justify a larger increase when your managed care con- tract is up for renewal.
ASC FOCUS JANUARY 2015 9
ASCs are still the most efficient provider of outpatient surgery, and significant cost savings can be achieved by moving cases from acute-care hospitals to ASCs. Most managed care companies will be anxious to hear ideas to do this.”
—Terry Bohlke, CASC, National Surgical Healthcare
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