Outpatient managers face uncertain reimbursement
April 1, 2002 2 minutes read
Outpatient managers face uncertain reimbursement
With the full impact of ambulatory payment classifications (APCs) still unknown for hospital outpatient surgery departments, ambulatory surgery centers (ASCs) are bracing themselves for an uncertain future. "We don’t know what they’ll do to us," says Lawrence Pinkner, MD, immediate past president of the San Diego-based American Association of Ambulatory Surgery Centers and president of the SurgiCenter of Baltimore. "Maybe they’ll link us to hospitals — not 100%, but maybe 95%." Or there could be a totally different fee schedule for ASCs, he says.
"What we don’t expect is a total increase in reimbursement," he says. "It’s threatening. Nobody knows what will happen." If Medicare cuts rates, other insurers will follow suit, he says. "That could be death for lots of surgery centers," Pinkner says.
Some surgery centers already are closing because they found out they can’t get reimbursed for pass-through items or disposable items. "We’re working hard on third payers and say, If you pay us for disposables, we could do these procedures and save you a lot of money,’" he says. "Some are changing, but if it doesn’t apply, it limits what can move to outpatient venue."
If you make $100-$200 for a procedure, you can’t do them, Pinkner maintains.
Eric Zimmerman, JD, MBA, attorney at McDermott, Will, & Emery in Washington, DC, is more optimistic in his outlook. He predicts that reimbursement for freestanding centers will change in the next three to five years, but it probably will be for the better. "There no doubt will be some winners and losers, i.e., reimbursement will increase for some procedures and drop for others," Zimmerman says. "However, overall, changes on the horizon in Medicare reimbursement will improve stability and predictability in ASC service reimbursement and also an expansion in the number of services that will be covered in the ASC setting."
Pinkner describes reimbursement as the "single biggest burden on managers." However, with the help of tracking software, managers are becoming knowledgeable about their profits, he says. Software can even track the cost by physician, Pinkner says. Good managers will analyze their costs and know when to tell physicians they can’t provide the procedure, he says.
Expect increased managed care contracting with outpatient surgery centers, predicts Jennifer Marks, MPH, acute care product manager at SMG Marketing in Chicago. "Low overhead and this consumer demand for outpatient services appeal to managed care organizations, and surgery centers themselves can offer multiple types of services to patients," Marks says. "It’s a combination of it being less costly for managed care and consumers being happier with outpatient service rather than be admitted."
One thing won’t change in the years ahead, Zimmerman predicts, and that is the dominance of Medicare. "As the Medicare population swells, so too will the role that Medicare plays in the ASCs, from reimbursement to influence on arrangements," he says.
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