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You must prepare now for new payment system
Centers must make a 'monster effort'
Are you ready for the biggest change for ambulatory surgery centers in 20 years? The impact of other changes, such as preparing for Y2K, are dwarfed in comparison to the new payment system coming for ambulatory surgery centers, says Judith L. English, vice president of business operations at Surgery Consultants of America and Surgery Center Billing in Fort Myers, FL.
"I take a look at other changes, and it's going to be a monster effort on everyone's part" to get ready, English says.
Amazingly, some surgery centers managers are just now hearing about these dramatic changes, says Craig Jeffries, Esq., executive director of the American Association of Ambulatory Surgery Centers (AAASC).
At a recent seminar held by AAASC to educate members on preparing for payment changes, about 25 of 150 attendees seemed to fall into that category, says Jeffries, who spoke at the seminar. "My takeaway from that is that the administrator or physician owner is aware, or maybe the executive of the hospital who is overseeing the ASC, but it not necessarily at the level of learning and preparing for others who might need to be involved," he says. This lack of preparedness may be highest among administrators of single-specialty ASCs, and some specialties will be dramatically affected by the payment changes, Jeffries warns.
"Surgeons, anesthesiologists or medical directors, administrators, and directors of nursing — all those functional areas should begin to have a very clear understanding of the range of changes," he says. Additionally, the person who handles contract management needs to be prepared, Jeffries says.
The Centers for Medicare & Medicaid Services is expected to issue a proposed payment rule by August 2007, but it probably will be published by early summer, Jeffries reports. The final rule is expected to be published by Dec. 1, 2007, he adds.
One quirk about the budgeting process this year is that that the budgeting process normally starts in August or September, but the payment changes won't be finalized by then, says Caryl A. Serbin, RN, BSN, LHRM, president of Surgery Consultants of America, who also spoke at the AAASC seminar. "The budget process in 2007 is going to be later," she says. "That's going to be the challenge."
As soon as the new rates are approved, those rates need to be added to the center's budget projections so that the impact on the bottom line can be assessed, Serbin says. Don't expect to take a lot of vacation time from the publication date through March, Serbin and English say. "There's going to be a lot of work to put the changes into place," Serbin says.
For now, you can examine what has been proposed for 2008. Make a spreadsheet looking at procedure codes that your center is doing, and look at how the reimbursement is supposed to change to determine the effect on your bottom line, Serbin suggests. However, keep in mind that this is just "preconceived notions," English says. For example, consider a multispecialty center that does a significant number of gastrointestinal (GI) cases. "You may say, 'I'm not going to increase the amount of GI, but if they come back and change GI [reimbursement] at the last minute due to lobbying, this may change your budget and what you're going to do; it may change the purchase of equipment," English says. "There's going to be a last-minute rush to do it right, we believe."
Put your costs under the microscope, Serbin advises. "First and foremost, determine if there is a way to decrease man-hours," she says. Multitasking will be essential for your staff, Serbin says.
Also take a close look at your medical supply costs. Negotiate with vendors, Serbin suggests. "From what I see, vendors are doing a good job of becoming educated about the system change, and they're trying to respond with some alternatives," she says. "I really don't feel like we're in this alone."