Value-Based Care and the Patient Experience: How ASCs Improve Quality While Reducing Costs
Author: Lisa Rock, President of nimble
Join the nimble leadership team at the Ambulatory Surgery Center Association (ASCA) 2023 Conference & Expo in Louisville, KY. Lisa Rock, Founder and President, and Scott Allen, Senior Vice President of Managed Care Contracting, will be co-hosting Secure the Reimbursements You Deserve for Implants on Thursday, May 18, at 11:15am-12:15pm. Find us at booth 618, May 17 – 20, 2023.
I’m looking forward to co-hosting a session at ASCA, and I am particularly thrilled to attend the conference this year. For over 20 years, my team of revenue cycle specialists has cultivated a culture of dedication, passion, and unwavering commitment to our ASC clients – first as National Medical Billing Services and now as nimble solutions.
Visit us at booth 619 at ASCA, where we’ll be making our debut as nimble. We’re sharing how nimble will continue to fuel innovation in the ASC industry through a wider range of revenue cycle management (RCM) solutions.
One of the ways nimble helps our ASC clients is by securing the reimbursements they deserve on all procedures, including those that require implants.
nimble’s managed care contract renegotiation process is one of our most effective strategies to improve reimbursements. Part of this process involves benchmarking payer rates and determining the profitability of each procedure. Depending on your contract terms, the negotiation process can also involve compiling value-based care data.
Under value-based care models, healthcare providers are reimbursed based on the quality of care achieved instead of the volume of services delivered. As more payers shift to value-based care, ASCs need to provide data that shows patients receive exceptional care before, during, and after each procedure to improve reimbursement amounts.
Compiling this information starts with patient satisfaction surveys, but there are other ways to measure every patient’s journey and show how your surgery center improves each patient’s experience.
In this blog post, I’ll explain what criteria you should benchmark to address the value-based care standards of payers and patients.
How to measure value-based care and improve patient experience
Think about how customers choose a restaurant. Many rely on Yelp reviews or recommendations from friends, but restaurant owners don’t just rely on Yelp or word of mouth as an indication of where their business is succeeding or how to improve.
Yes, restaurateurs create customer surveys to collect feedback, such as the reason why customers are choosing to eat there – if it’s due to a recent ad campaign, google search, local food critic, or personal recommendation. But they also monitor restaurant inventory and supply costs to help keep prices reasonable for customers.
A popular metric for restaurants is customer wait times. Tracking how long it takes for a customer to be seated, to be greeted by the server, to receive the meal after placing the order, plus how long it takes to clean and prepare the table for the next guest improves the customer experience. Wait times can indicate if more staff should be hired or if more staff are needed on certain nights to keep up with demand.
Likewise, when ASCs take a patient-centric approach to each service, there are several ways to measure and improve the patient experience. By tracking and reviewing this information for areas of improvement, you can provide data-driven, value-based care insights to prospective patients and payers.
The more proactive you are in making adjustments that improve the patient’s journey, the more you’ll improve your overall patient satisfaction at your facility, and the better your data will be when it’s time to renegotiate your payer contracts.
The most common value-based care metrics
There are many ways to measure your patient-centric approach. Some of the most common metrics to track are:
- Patient satisfaction surveys: Getting real-time feedback on how satisfied patients are with their experience is valuable for your business. Surveys can include factors such as wait times, facility cleanliness, staff friendliness, and overall quality of care. Improving patient satisfaction can increase patient loyalty, referrals, and positive online reviews, which can attract new patients.
- Turnover time: The ability to perform more surgeries in your facility increases revenue. Turnover time measures the time it takes to prepare a surgical suite between cases. Reducing turnover time can increase the number of procedures performed and improve efficiency if the ASC can handle increased demand without sacrificing quality of care.
- First-case on-time starts: Patients don’t like wasting time in waiting rooms on the day of their surgery, especially if they haven’t had anything to eat for 8 hours. This KPI measures the percentage of surgeries that start on time. This metric can help identify areas for improvement in scheduling, communication, and staff productivity.
- Staff productivity: There are many ways to measure staff productivity, including the number of procedures performed per hour, per day, or per week. Increasing staff productivity can help increase revenue and reduce costs.
- Staff turnover rate: Staff retention, staff shortages, and staff burnout are nationwide concerns in the healthcare industry today. High staff turnover can negatively impact productivity, quality of care, and patient satisfaction.
- Compliance: All members of your staff members should be knowledgeable of the latest federal and local guidelines and participate in continuing education as needed. This ensures your ASC remains compliant with all relevant regulations, accreditation standards, and best practices. Maintaining compliance can help ensure patient safety and reduce the risk of legal or financial penalties.
When a new patient is considering your ASC, it’s important to communicate why procedures cost less in the ASC setting, why the quality of care is better at your ASC, and what the patient can expect after the procedure in terms of financial obligations and recovery period.
Educating the patient ahead of time on these three topics will also improve your patient satisfaction surveys.
High deductible plans have patients looking for low-cost options
Paying for a surgical procedure can be a significant source of financial stress for many Americans. Employees are paying a greater percentage of their healthcare bills due to the rise of high-deductible plans.
A recent survey conducted by the Kaiser Family Foundation found that family premiums have been rising faster than workers’ wages and inflation since 2011. The burden of deductibles has increased by 92 percent across all covered workers over the past decade.¹
As patients shop around for low-cost options, be sure to explain the cost differences between outpatient and in-patient care. They might not know that outpatient facilities are less expensive compared to hospitals.
ASCs also have the ability to bundle payments. Patients can save money by paying a single price for all services related to a particular procedure. This can include the cost of the facility, the surgeon’s fees, the anesthesia, and any additional supplies or equipment used during the procedure.
Bundling payments can help patients avoid unexpected or hidden costs that can arise when receiving care at a hospital, where fees for each service are billed separately.
When high-deductible plans don’t address quality of care.
Imagine a patient requires a shoulder procedure, such as a rotator cuff repair, and chooses the lowest cost surgeon. The upfront price estimate was accurate, and the patient was able to schedule automated payments to break up the cost.
After the surgery, the patient develops signs of sepsis and is in the emergency room to manage the infection. The initial cost savings are negated because the patient’s care now costs much more in its entirety, plus the outcome isn’t preferrable for the patient or the payer.
As much as patients want to save money, they want to assess the quality of a surgeon’s work, such as how many similar procedures the surgeon has performed, what percentage of the surgeon’s work must be corrected, or what percentage of patients wind up with infections following surgery.
If your ASC can provide insights specific to results at your facility, such as lower infection rates, patients will feel more at ease with their choice.
Why do ASC patients experience less surgical infections compared to hospital patients?
Patients want to know why ASCs are able to provide greater value and quality of care. Since ASCs are often solely focused on performing certain types of surgeries, the surgeons and supporting surgical team are well versed in specific procedures and their required safety protocols.
As patients research healthcare provider options online, providing this kind of information on your website can be extremely valuable in attracting and educating potential clients.
Include specific examples from recent studies to back up your claims, such as:
Surgical site infections in hospitals have been reported to occur in 2%, or in 20 out of every 1,000 patients, which is a greater rate of infection compared to outpatient facilities.²
When you list your ASC’s specialties on your website or marketing material, explain that your focused approach has fewer variables, fewer complications, and lower infection rates compared to the hospital setting – and all these factors improve the patient experience.
Also, document your ASC’s specific outcomes, such as how quickly your patients recover from certain procedures.
If you can show your patients recover faster than the average recovery time due to a particular surgeon’s expertise or advanced surgical technology, such as robotic surgery, you’re showing additional value to patients, aside from cost-savings.
Communicate cost and recovery time prior to procedure
Patients want to know when they’ll be back on their feet and if their recovery period will impact routine commitments. One of the main benefits of the outpatient setting includes recuperating at home instead of overnight in a hospital setting. This is a huge win for improving the patient experience and decreasing costs.
When consumers shop online or in stores, prices are visibly marked, and they expect to have the same experience with healthcare providers. The No Surprises Act requires providers to produce good faith estimates when asked. In terms of patient satisfaction, communicating the cost ahead of time helps patients budget and plan for those out-of-pocket expenses.
A user-friendly online bill pay option also improves the rate of collections, especially if there is an option to enroll in an automated payment plan. Online billing incorporates re-occurring payment reminders via email or text or allows for automatic monthly withdrawals to meet pre-set payment plan obligations. Automating patient financial responsibility can help eliminate or at least minimize the burden on your staff to collect payments.
The longer it takes to collect each payment, the longer a claim lingers in accounts receivable (A/R). Improving the patient experience through price transparency, financial counseling, and electronic bill pay options will increase your cash flow and the efficiency of your revenue cycle.
Every ASC is looking for ways to rapidly drive revenue, minimize costs, and maximize cash flow. By following these strategies, your ASC can improve outcomes, enhance the patient experience, and reduce costs.
I’ll be discussing more ways your ASC can improve reimbursements at ASCA.
I’ll be co-hosting the session Secure the Reimbursements You Deserve for Implants on Thursday, May 18, at 11:15am-12:15pm. This session details how to negotiate solid payer contracts.
Are you looking for ways to improve your revenue cycle management? Take the first step towards optimizing your revenue cycle process by requesting a revenue assessment from our team of RCM experts. Request a demo.