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Price transparency, outpatient joint arthroplasty & more – One orthopedics-driven ASC’s push for innovation

Written by Carrie Pallardy | July 09, 2015 The ambulatory surgery center business has thrived for years; ASCs have carved out space for themselves as safe, efficient and cost-effective providers. But, the healthcare environment is evolving and ASCs are being pushed to find new ways to secure their success. The Orthopaedic Surgery Center in Boardman, Ohio, is taking on several new initiatives, all aimed at preparing the center for the rapidly changing healthcare industry. The center has gone live with price transparency, a frequent topic of conversation but relative rarity in practice. The ASC posted cash-pay prices for more than 60 orthopedic and pain management procedures. The posted prices include the facility, physician and anesthesia fees packaged into one all-inclusive rate. “It’s a very complex and frustrating system. We knew we needed to find a way to simplify things for ourselves. The result was we became better at being more transparent to our consumers, providing them more accurate cost information they needed to make a decision on their healthcare. The free market is a powerful thing,” says Taylor Cera, MBA, administrator of TOSC. The center has already built positive relationships with several patients who chose the transparency, cash-pay option. Price transparency, demanded by patients and intimidating to many providers, takes time understand and offer. Mr. Cera began by talking to his center’s key leaders. “We took the time to meet with all of the entities involved: Physicians, anesthesia and our facility leaders,” he says. “We looked at our market and what affordable healthcare should be.” The initial conversation was slow, but eventually our team and physicians were on board with the idea and the value it would provide patients. Before the prices were launched on the center’s website, the ASC performed a few cases under the transparent pricing based solely on word-of-mouth. The number of interested patients only grew after the prices were posted online. Mr. Cera is looking to other avenues to maximize the benefit of transparent, packaged pricing. “There have been some conversations with nearby health sharing communities, third party administrators and even some self-funded employers. It’s a growing opportunity for employers’ to manage cost & quality, improving their value proposition,” he says. “We can save employers money, it’s no cost out-of-pocket for employees, and we are also getting a sustainable rate for the procedure. Everybody wins.” The transparent prices, while an important strategy for the center, only address the cash-pay segment of the patient population. Many patients with traditional insurance still come to the center, and the common denominator amongst many health plans is the rising deductible. Higher deductibles place greater financial responsibility with patients, and force providers to accept a certain level of risk. Savvy providers are putting processes in place to ensure patients are aware of and able to meet their financial obligations in a timely manner. “We came up with a model that works for our center,” says Mr. Cera. “We build a relationship with our patients. Our patients expect us and trust us to take the time to explain their financial responsibility. They are fully aware of their financial responsibilities up-front. There is no shock when they receive bills.” While price transparency and improved collections are a focus for the center’s business operations, TOSC is also looking to clinical innovation. The surgery center has begun to offer outpatient joint arthroplasty procedures. “We have done shoulder and knee procedures very successfully.” says Mr. Cera. “Patients have customized home health and therapy care in their own homes. They love it” The surgery center added these new procedures after evaluating these five key elements.

1. Education and patient selection. Patients are carefully educated before being cleared for these procedures, but Mr. Cera is looking for ways to take the process of patient preparation even further. He is considering using iPads to offer video presentations and reading material customized for TOSCs outpatient joint experience. “We are really looking at improving our educational best practices. The patients have to be committed to doing this,” he says.
2. Physician leaders and engagement. “None of these things would be possible without our clinical team and our physicians,” Mr. Cera says. “We’ve allowed our physicians to make key decisions,” he says. The physicians were an integral part of the development of our protocols and policies surrounding the new service line, which went a long way to build a collaborative culture at the center. “Get them involved, let them know the expectation is for them to make a decision. It’s powerful.”
3. Payer contracts. “Insurance companies are actually working with us, providing us with favorable contracts. You need to let them know what’s going on. Be transparent with them. There has been much economic pressure put on payers to steer patient volume to these more cost-effective ASCs,” says Mr. Cera.
4. Protocols. Minimally invasive orthopedic surgery technique and innovative pain management is yielding successful same-day joint replacement results. “The development of surgery, anesthesia and homehealth protocols need to be in place and need to be executed perfectly to be successful,” he says.
5. Staffing/team. It is important to have a knowledgeable, engaged team, particularly when adding a new service line. “We are increasing responsibility with fewer resources,” says Mr. Cera. “We have seen tremendous results. This is why buy-in is so important.”