At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, 2012, Naya Kehayes, managing principal and CEO, and Matt Kilton, principal and COO, of Eveia Health Consulting and Management explained how surgery centers can add spine and orthopedic cases.
Obtaining appropriate reimbursement for these costly procedures is not always easy, but ASC should follow the following six steps:
1. Cost analysis. Is it worth it to bring in spine and orthopedic cases?
2. Collect data. Look at data to see what the general reimbursement is for spine and orthopedic cases, including Medicare and private payor rates.
3. Comparisons of hospital cost versus ASC cost. Patients will want to know if spine and orthopedic procedures are cheaper at the hospital or the ASC, so the provider should this as well.
4. Presenting the data to the payor. ASCs have to present the data in the right light.
5. Demonstrating cost savings to payors. This is where negotiations are won and lost: Is it worth it for the payor?
6. Negotiations. Tying loose ends and finalizing negotiations are the final step.
"These are very high-cost, implant-intensive services," Mr. Kilton said. "The culmination of all that, the hook, is the cost savings for the payor. That will get the payor interested in the conversation, but you have to demonstrate that by knowing your costs and what the market will pay."
Obtaining appropriate reimbursement for these costly procedures is not always easy, but ASC should follow the following six steps:
1. Cost analysis. Is it worth it to bring in spine and orthopedic cases?
2. Collect data. Look at data to see what the general reimbursement is for spine and orthopedic cases, including Medicare and private payor rates.
3. Comparisons of hospital cost versus ASC cost. Patients will want to know if spine and orthopedic procedures are cheaper at the hospital or the ASC, so the provider should this as well.
4. Presenting the data to the payor. ASCs have to present the data in the right light.
5. Demonstrating cost savings to payors. This is where negotiations are won and lost: Is it worth it for the payor?
6. Negotiations. Tying loose ends and finalizing negotiations are the final step.
"These are very high-cost, implant-intensive services," Mr. Kilton said. "The culmination of all that, the hook, is the cost savings for the payor. That will get the payor interested in the conversation, but you have to demonstrate that by knowing your costs and what the market will pay."
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