MANAGING & IMPROVING AN ASC

ASC reimbursement is an important part of both ASC feasibility and ongoing financial performance. The ASC is reimbursed for the facility services associated with the surgical procedure, while the surgeon and other providers bill separately for their professional services. Reimbursement can vary significantly by payer, market, procedure and contract structure.

Understanding ASC Reimbursement

  • ASC reimbursement can vary considerably from one procedure and payer to another. Looking beyond overall surgical volume provides a clearer understanding of the center's reimbursement environment.

  • What is included in an ASC facility payment - and what may be treated differently under a payer contract can vary. Those differences can affect the economics of the procedures performed at the center.

  • Reimbursement is only part of the financial picture. The costs associated with performing a procedure also influence its contribution to the ASC's overall performance.

  • Contracted reimbursement and actual payment performance are not always the same. Periodic review can help identify reimbursement issues that may warrant further attention.

  • Changes in payer mix can affect financial performance even when surgical volume remains relatively consistent. Understanding the relationship between payer mix and reimbursement is therefore important for both developing and existing ASCs.

HDA PERSPECTIVE

Reimbursement is only one part of ASC performance. The strongest financial picture comes from evaluating reimbursement alongside procedure volume, payer mix, staffing, supplies, implants and operating costs. HDA helps physician owners understand how these factors work together - whether evaluating a new ASC opportunity or improving the performance of an existing center.

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When Should an ASC Revisit Payer Contracts?

Payer agreements can remain in place for years while an ASC's costs, physicians, procedures and market position continue to change. Periodic review can help determine whether existing agreements still align with the center's current operations and financial objectives.

  • Operating costs change over time. When reimbursement remains relatively static, the financial performance of certain procedures or payer relationships may change as well.

  • Growth in physicians, specialties, surgical volume or market presence can change an ASC's position over time. Existing agreements may not always reflect what the center represents today.

  • Not every procedure performs the same financially across every payer. Consistent differences may indicate that portions of an agreement deserve a closer look.

  • Reimbursement is only one component of a payer agreement. Other contract provisions can also affect how effectively the relationship works for the ASC.

  • Payer strategy is generally more effective when it is proactive rather than reactive. Periodic review gives ASC leadership an opportunity to understand where agreements stand before an issue requires immediate attention.

A payer strategy should prioritize contracts based on financial impact, volume, market considerations and realistic negotiation opportunity. HDA helps ASCs organize contract data, identify priority issues and support a structured payer strategy.

HDA PERSPECTIVE

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ASC Staffing: Finding the Right Balance

ASC staffing requires a balance between patient safety, regulatory requirements, employee sustainability and financial discipline. The appropriate staffing model can change as surgical volume, specialties and operational needs evolve.

  • Staffing should reflect the actual needs of the facility rather than a fixed model. As an ASC's schedule and services change, staffing requirements may need to change with them.

  • The surgical schedule and staffing model should work together. When they do not, an ASC may experience unnecessary labor costs, inefficiencies or staffing challenges.

  • Cross-training can provide ASCs with greater flexibility as daily needs change, provided employees are appropriately trained and qualified for the responsibilities they perform.

  • ASC leaders have responsibilities that extend well beyond daily staffing. An effective staffing structure should allow leadership adequate capacity to oversee the broader clinical and operational needs of the center.

  • Labor costs are most meaningful when viewed alongside the center's surgical activity and operational needs. The goal is a staffing approach that supports both efficient operations and consistent patient care.

HDA helps ASCs assess staffing models, responsibilities, workflows and labor performance with the goal of building a structure that supports both patient care and efficient operations.

HDA PERSPECTIVE

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Is Your ASC Performing at Its Full Potential?

An ASC can be busy and still have meaningful opportunities to improve financial or operational performance. Understanding whether a center is performing at its full potential requires looking beyond case volume and considering the operation as a whole.

  • ASC performance should be viewed across a range of financial, operational and clinical measures. Looking at these areas together provides a more complete picture than relying on any single performance indicator.

  • Strong surgical volume does not always translate into strong financial performance. Differences in reimbursement across payers and procedures can have a significant impact on overall results.

  • Revenue-cycle performance can affect both cash flow and accounts receivable. Persistent delays, denials or aging balances may indicate opportunities for improvement that warrant a closer review.

  • Staffing is a significant component of ASC operations and should remain aligned with the center's surgical activity and operational needs while supporting safe, compliant patient care

  • Supply and implant costs can have a meaningful impact on an ASC's financial performance. Reviewing these expenses as part of the center's overall operations can help identify areas that may warrant closer attention.

  • A busy ASC is not necessarily a fully utilized ASC. Scheduling patterns, available capacity and changing physician needs should be considered when evaluating how effectively the facility is being used.

HDA performs operational and financial reviews for ASCs that want an experienced outside perspective, whether the need is a focused consulting project or broader management support.

HDA PERSPECTIVE