Two Reimbursement Trends Facing ASCs

Two reimbursement trends – bundled payments and growth in self-pay – are top-of-mind for ambulatory surgery center (ASC) leaders striving to optimize payment and boost their bottom line.

As the trend continues away from the fee-for-service model, bundled payment is the fastest growing payment type, with projected growth of 6 percent over the next 5 years. If projections by both hospitals and payers are correct this would place bundled payment at 17 percent of all medical payment types in five years. This is per research by ORC International and commissioned by McKesson.

“It’s clear that bundled payment is continuing its growth and for good reason,” says Regent’s Director of Revenue Cycle Erin Petrie. “As providers realize the value of the bundled payment for the population of patients that are more middle of the pack in both projected needs and costs, the shift continues towards value-based reimbursement, and bundled payments will continue along in tow.”

Currently, covered orthopedic and spine procedures include:

  • Total Knee Replacement
  • Total Hip Replacement
  • Total Shoulder Replacement
  • Laminectomy
  • 1-2 Level Fusions
  • Corpectomy
  • Artificial Disc Replacement

Another payment trend continuing its growth, according to Petrie, is self-pay. InstaMed’s “Trends in Healthcare Payments Seventh Annual Report” notes there was a 58 percent uptick from 2013 to 2016 in self-pay patients. It also reports that 92 percent of patients want to know their payment responsibility upfront and prior to a provider visit with most providers finding it can take one month or longer to collect from patients. “Self-pay is here to stay and providers must meet the challenges that come along with growing number of self-pay patients,” adds Petrie.

Regent RCM’s expertise comes from exclusively developing, executing and refining ASC-specific revenue cycle management strategies as well as investing time and resources into the technology, training and staffing to stay ahead of industry trends and updates. To learn more about our services and approach, contact us today. 708.492.0531.