diac catherization and coronary inter- vention procedures like angioplasties and stenting. In 2019, CMS requested feedback on a proposed expansion of the ASC CPL to include additional interventional procedures like ather- ectomy and thrombectomy. Addi- tionally, the Hospitals Without Walls initiative allowed other high-dollar procedures like cardiac ablations to be performed in ASCs. Should out- comes remain positive, cardiac abla- tions also will likely be added to the ASC CPL in coming years. With the apparent frequency of interventional procedures

outpacing diagnostic

procedures, the interventional mar- ket represents a significant growth opportunity for ASCs. Bain & Com- pany projects that by the mid-2020s, ASCs will grow their cardiology vol- umes from 2018 by 230 percent and capture a third of total cardiac proce- dures performed annually.

Renewed Focus on Effective Strategies While the pandemic’s disruption to ASC operations created financial concerns in the short term, it also pro- vided insight into key best practices. ASCs can best position themselves for continued success by following these strategies.

Standardizing and strengthening clinical protocols and front-end processes. Develop clear pre-oper- ative and post-operative protocols. This includes defining the clinical characteristics of the ideal patient profile for a given procedure, main- taining fluency among staff in all elements

of training and Quality

Assurance/Performance Improve- ment (QAPI) initiatives, and ensur- ing accuracy in front-end tasks like scheduling,

pre-authorization highlight the advantages

verification. During patient selec- tion,

of your facility and provide patients

with insight on their financial obliga- tions and best course of action.

Securing comprehensive and com- prehendible contracts. From a finan- cial perspective, one of the biggest determinants for an ASC’s success is whether it can remain fully positioned underneath the umbrella of its man- aged care contracts. To ensure costs are being covered, have a thorough understanding of how payer contracts are set up. Prior to negotiation, famil- iarize yourself with the local market reimbursement rates and be prepared to discuss your technological capabil- ities, case frequencies, surgeon talent and patient outcomes. During negoti- ations, clearly define the complexities of a given contract’s payment meth- odology to confirm that the contract terms make financial sense in relation to the procedures they are expected to cover, especially for those that are not yet approved by Medicare for the ASC setting.


Establishing efficiency in the rev- enue cycle. Equally critical from a financial perspective is the ability to manage the revenue cycle efficiently and effectively. The number of future claim denials is often determined by the strength of front-end processes.

Despite its disruptive impact to ASC operations, the coronavirus pandemic has actually served to enhance the appeal of ASCs by further highlighting the strengths and advantages they provide patients, providers and payers.”

— Taylor Burns, Pinnacle Healthcare Consulting

Ensuring accuracy at the front end will help minimize future denial or collection issues. The proper cod- ing of claims will

also safeguard

against delays or denials stemming from a misalignment between the coding and the corresponding con- tracts. Additionally, as the pandemic has demonstrated, the ability to move coding, billing and collection pro- cesses offsite can help weather finan- cial fallout from volume disruptions. Maintaining the flexibility to mobi- lize or outsource these tasks will help ensure continuity to the reve- nue cycle. The use of interactive data analytics, in the right hands, also can help streamline some of these tasks and provide a comprehensive picture of performance at every stage of the revenue cycle.

Staying on top of technology trends. As advancements in technology con- tinue to shift more procedures to the outpatient setting, ASC administra- tors will want to stay informed of these trends so they can capitalize on long- term growth. Pandemic-related con- cerns will continue to drive demand for touch-free solutions like contact- less payment systems, remote patient monitoring systems and mobile phone applications. Based on a proprietary survey of major ASC administrators and management companies con- ducted by Pinnacle, ASC administra- tors noted an increase in mature physi- cians retiring during the pandemic. To best position themselves for the next generation of surgeons, ASC adminis- trators will want to carefully consider investments in the latest robotics to broaden their access to emerging tal- ent, capture more complex procedures and sustain the brand recognition of their facilities.

Taylor Burns is a business valuation manager at Pinnacle Healthcare Consulting in Centennial, Colorado. Write him at


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