by Plutus Health
Modern medical coverage incentivizes patients to find the cheapest and best options available. One of these options are ASCs. Ambulatory surgery center (ASC) procedures typically cost 35% to 50% less on average than a traditional hospital. These lower prices complement an increase in price hunting and greater trust in outpatient care.
Earlier, few patients would consider getting spinal surgery at an outpatient facility. But better technology and capabilities to handle complex care have made these facilities quite marketable.
The Center for Medicare and Medicaid Services (CMS) has also added numerous spinal codes to the ASC payable list. As such, many advanced ambulatory surgery centers are expanding into once untapped sources of income. With this exploration, however, comes higher costs and quality expectations.
Here are the top four challenges facing ASCs today.
Covid-19 has driven many medical veterans to retire. And with the increased unemployment rates, numerous patients have lost their health insurance. This loss has placed financial stress on clinicians. Additionally, the pandemic burdens medical workers with physical and mental health concerns. As such, institutions across the country have been scrambling for new employees to cope with physician turnover and retirement.
ASCs are unable to offer the bonuses or growth opportunities available to clinical staff members at large hospitals. Many young, talented physicians see these smaller facilities as a sub-par career path. Therefore, ASCs struggle to find new clinicians that bring the same level of effort and talent their predecessors had.
Medical insurance has recently reduced coverage and increased deductibles with HDHP plans. This move is an attempt to make patients show more discretion in choosing treatment options. However, practically, it has resulted in patients’ out-of-pocket spending increasing by nearly 400% over the past 12 years.
While ASCs are more affordable than hospitals, average out-of-pocket medical expenses for an outpatient visit rose 12% between 2017 and 2018. This increase has led many patients to forgo simple surgeries they would have elected for a decade earlier.
This increase in deductibles has caused patients to demand more price transparency from clinicians. Unfortunately, price transparency can be difficult or impossible to access because of third-party payer rate variances and contracts.
While CMS has allowed ASCs to receive payments for spine surgeries, recent developments have worried the outpatient facilities. CMS has announced plans to remove 258 procedures from the ASC payable list by 2022. When this change occurs, ASCs will receive a less consistent revenue stream from that list. This change also has made many ASCs hesitant to adopt new procedures currently protected by CMS regulations for healthcare.
Payer policies are growing less consistent. Physicians report an increase in payer denials for services that used to be covered. Additionally, insurers want to see more prior-authorizations before confirming a surgery. All this pressure contributes to creating more documentation for ASCs, than ever before.
These coverage shifts correspond with increased out-of-pocket payments. As a result, ASCs see claims spend more time in accounts receivable than previously. This financial insecurity is untimely, since the more elaborate surgeries many facilities are adopting requires higher maintenance costs.
As ASCs perform procedures with higher difficulties, their value goes up. As a result, hospitals are incentivized to buy ASCs and consolidate. This consolidation leads to price hiking as competition shrinks in a region. Despite their lower prices and high-quality service, independent centers struggle to compete with these corporations. In addition, those owners who sell their businesses to Hospitals often find their autonomy lessened when being part of a more powerful ally.
PlutusHealth works with ASCs to streamline medical billing. If you are struggling with billing, collection, and denial management, our expert team takes care to get the best and fastest reimbursement possible and increase your practice’s performance.
1. Experienced physicians are leaving, and new physicians are in demand.
2. Patients are paying more out-of-pocket and demanding greater price transparency.
3. Inconsistent coverage has created financial insecurity.
4. Hospitals are buying out ASCs to consolidate coverage in a region.
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