How to survive case rates and global payments
The following suggestions can be helpful when working against the financial effects of case rates, reimbursement experts say:
• Carefully analyze your average cost per procedure and negotiate case rates that at minimum cover your allocated costs.
• Set time limits of less than two years on case rates contracts, and review them regularly.
• Renegotiate contracts based on technological upgrades and advancements.
• Carve out extremely expensive but low-volume procedures such as nuclear medicine that won’t be financially viable under a case rate.
• Determine your payer’s ability to issue checks accurately and regularly under case rates using present technology.
• Negotiate separate arrangements with multiple surgeries that are specific and account for all services.
• Look at the full spectrum of services being negotiated, and offset expected losses from some procedures with carveouts on others.
• Don’t flatly accept the Medicare ambulatory surgery center rate without negotiating a higher rate.
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