1. Commit more time and attention to you cash cycle. The cash cycle of an ASC has recently taken on an even higher level of importance for the organization’s stability and success and is also becoming significantly more challenging, Rajiv Chopra, principal and CFO for The C/N Group, says. “What’s happening is you’re seeing more of a patient responsibility for co-pays, deductibles and everything in between,” he says. “You’ve got an economic crisis — patients are going to pay their mortgage, car, cell phone, college tuition and then maybe they’ll think about paying the healthcare bill. You can repo a house, you can repo a car, but you can’t take a colonoscopy back.”
Mr. Chopra advises ASCs to tighten up their policies in terms of front-end collections and co-pays.
ASCs must also keep a close eye on what their payors are doing that could impact the ASC’s business. “The insurance companies are constantly looking at programs which benefit the patient,” he says. “In some markets for colonoscopies, there is no longer a co-pay. When the rules change, how quickly can you communicate that to your front-end folks and get those routines in place so you know which patients you’re supposed to collect the co-pay from, and which you’re not.
“It sounds easy, but if you’re in a market where youhave 100 insurance plans and each one has their own process, their own guidelines, it gets to be a little complex,” he says. “There can be a breakdown in the communication by the staff upfront. They can say, ‘let’s just not collect any co-pays and then you’ll find yourself trying to go to the patient that actually owes you after the procedure and in today’s economy, that’s not easy.”
2. Perform case-costing to obtain data. Many ASCs do not have cost data because they typically don’t need it when sending out claims, says Ron Brank, a group vice president for Symbion in Nashville, Tenn.. For example, Symbion ASCs are mostly paid through a set fee schedule or a grouper methodology. To capture cost information, ASC staff members need to perform case-costing, which involves reviewing the chart for each case, determining what supplies, such as implants, were used. Then they add up the supply and labor costs for each case and enter the data into the patient accounting system. “This will require extra staff time, but the cost is well worth it,” Mr. Brank says. Symbion’s IT department captures this information into its data warehouse, adds indirect and fixed costs and provides reports on case-profitability in a number of views, such as by CPT code, specialty, financial class and physician.
3. Elect staff members to monitor finances, particularly pre-collection and billing functions. There are approximately three staff members who work at Midlands Orthopaedics as financial account specialists says Ann Margaret McCraw, CEO of Midlands Orthopaedics Surgery Center in Columbia, S.C. These specialists’ primary role is to meet with patients before surgery to pre-collect copays, deductibles and co-insurance amounts and work out payment plans as needed, Ms. McCraw says. Delegating specific responsibilities, such as pre-procedural collections, to staff members helps ASCs collect in a more efficient manner.
“Our financial account specialists collect both for our professional practice and ASC, so our patients don’t have to make separates trips for different bills,” she says. “These staff members are trained to have those sensitive conversations with our patients and know how to interpret statements, EOBs and explain deductibles. So it helps our ASC and practice because the payments from one patient are all funneled to a specialist, and it’s nice for our patients because it alleviates confusion on their part as they navigates bills from both entities.”
4. Educate staff about orthopedic procedures. A key to increasing efficiency in your orthopedic service line is ensuring that your staff is knowledgeable about each procedure that will be performed at the ASC. “Spend the time early on to educate staff, including pre- post- and OR staff, about what you’re doing and why you’re doing it,” says Timothy Kremchek, MD, medical director at Beacon Orthopedics and Sports Medicine and a physician-owner of the clinic’s surgery center. “The more they understand what you’re doing, the more they understand and anticipate what needs to be done, which makes the surgeon more efficient.”
5. Stay updated on trends in the device industry. John Cherf, MD, president of OrthoIndex, says although the cost of orthopedics-related supplies, such as implants and other devices, continues to rise, orthopedic-driven ASCs could combat this by learning more about the device industry, as well as effectively coding and managing the cost of orthopedic devices. Orthopedic-driven ASCs can also manage costs by consulting third-party orthopedic technology management specialists.
“A third-party firm can educate ASCs that don’t have the experience or knowledge to capture appropriate pricing,” Dr. Cherf says. “These firms can help propagate buyer power, develop and manage supply chain contracts, leverage provider alignment, maintain compliance and much more.”
