with these cases. Both of these issues are often associated specifically with spine fusion cases. If you have a commercial payer contract that is based upon a percent- age of “current Medicare,” this may present an opportunity to add spine procedures to this contract’s approved procedures list. However, it is critical that the ASC review the payer contract and determine whether the reimburse- ment rate is reasonable or appropriate relative to the cost and the capital out- lay that is required to move into this business. If your reimbursement is based on Medicare rules, the implants associated with the case will not be paid separately. The ASC can now approach the

payer, noting CMS’ approval of spine procedures, and show how the current

The way for ASCs to create value in the market is to continue to look at how they can move volume from the more expensive hospital setting into the ASC setting.”

—Naya Kehayes

contracted rate makes performing these procedures cost-prohibitive. ASCs should be able to work with the payer to negotiate a higher rate or coverage for implants and cost of capital that allows the facilities to move spine cases into the center by promoting to the payer the savings to patients and the payer by keeping these cases out of the hospital.

How are payers taking quality into consideration in their ASC contracts? KEHAYES: We are starting to see payers offering an incentive bonus tied to quality measurements, such as those measures in the Ambulatory Surgical Center Quality Reporting Program. Payers are creating thresholds for ASCs to meet based upon quality reporting indicators. If an ASC meets a high percentage of that threshold, they might receive access to additional reimbursement or incentives. If you believe your ASC is a top quality and outcomes,

performer in

start asking your payers about value- based contracting. There may be an opportunity to earn rewards based on your ability to deliver exceptional care.

Robert Kurtz interviewed Naya Kehayes.


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