While many trends in healthcare today point to the value of outpatient care, ambulatory surgery centers (ASCs) can still falter if they fail to actively manage risk in critical areas. The experts at Regent Surgical Health help ASCs and their physician and hospital partners avoid these four common mistakes, turning each into an opportunity for growth.
- Poorly Managed Contracts
ASC administrators face a variety of challenges when it comes to successfully managing their payor contract negotiations. One common problem is that often hard-working and well-intentioned administrators and office managers are too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payor contracts. But with careful preparation, ASC administrators can keep more money to reward and fuel center growth by negotiating payor contracts that will adequately cover the full cost of services and ultimately streamline healthcare costs for all. Key strategies include: incorporating Centers for Medicare & Medicaid Services (CMS) changes into contracting, planning for future case mix changes and updated procedures, building in annual increases and multi-year contract increases, and overall caution/careful attention to terms when it comes to preferred provider organizations (PPO) and third-party administrators (TPA).
- Skyrocketing Costs
Monitoring expenses and tracking trends are essential to managing costs. For example, if a center is losing money on unprofitable cases and inefficient supply management, tools that help keep administrators in the know can help immensely. To address this problem, Regent has spearheaded solutions like the use of electronic preference cards to replace old, less precise metrics. Electronic preference cards provide a wide swath of data, as information is collected and compared across member facilities to get a clear picture of supply expenditures. This allows surgery centers to discern which physician items are driving up costs, and find out where real savings can be captured. In addition, Regent has found that integrating the information with the help of electronic procurement systems like Inventory Optimization Solutions (IOS) helps ASCs better manage costs throughout a single center as well as throughout the entire organization.
- Failure to Bring in High-Reimbursement Cases
To succeed in an era of tightening reimbursement practices, an ASC needs to stay ahead of the competition by adding profitable procedures that may not be available elsewhere, or risk losing such cases to the competition. Procedures with potential to deliver strong profits include (among others) major spine cases and total joint replacements (TJR). Regent believes moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial, but suggests first assessing outcomes on an inpatient versus outpatient basis to see whether the results vary by setting type or provider.
- Revenue Cycle Management
The way an ASC manages the revenue cycle can make or break its profitability. And with the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the revenue cycle landscape is changing at a rapid pace. Specialized expertise is required to ensure optimal results while anticipating new opportunities, and revenue cycle management can’t be an afterthought. The team at Regent RCM develops, executes and refines billing and collection strategies, and invests in the most up-to-date tools and technologies.
Regent has built its national team of clinical, operational, and financial experts to tackle every ASC need from shaping ambulatory strategy and center development to managing day-to-day operations. For more help in managing for success, contact Thomas Crossen.