OR Manager November December 2022 - 33
AMBULATORY
SURGERY CENTERS
he notes. A national group also does
their own billing and collections separate
from the ASC. In per diem models,
ASCs generally take over the anesthesiology
services.
Having your own anesthesia group
or per diems may come with a marginal
benefit. But especially with per diems,
there is a risk of not being able to provide
anesthesia if the anesthesiologist
is suddenly unavailable. A per diem, for
example, may decide they do not want
to work on a Friday, which leaves the
ASC scrambling to cover services for
that day.
" If I'm an orthopedic ASC or total
joints, and I can't do a certain number
of total joints in a day, I'm going to lose
not only my professional fee but the facility
fee, " says Dr Miller.
When drafting a contract, clearly laying
out expectations on work and all
financial aspects is a must, experts say.
" It's important to get extremely specific
in the contract. This way, you'll always
get to an acceptable proforma on both
sides, " says Katherine Grichnik, MD,
AMBULATORY
SURGERY
ADVISORY BOARD
* Claire Everson, RN, CNOR, CCAP, Clinical Educator
and Consultant, Bloomfield Hills, MI
* Diane Fecteau, MSA, RN, CASC, NE-BC, Executive
Director, Maine Medical Center Scarborough Surgery
Center, Scarborough, ME
* Cynthia Hess, MSN, RN, FNP-C, RT(R)(CT)(ARRT), Director
of Nursing, Northeast Missouri Ambulatory Surgery
Center, Hannibal, MO
* Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC,
Administrator, Heartland Surgery Center, Kearney, NE
* Beverly Kirchner, BSN, RN, CNOR, CASC, Chief Compliance
Officer, SurgeryDirect, Highland Village, TX
MS, FASE, chief of anesthesiology
services at
SCA Health in Illinois.
The ASC and the
provider should work
together to balance the
number of expected
cases and needed coverage
for anesthesia.
Specify what anKatherine
Grichnik,
MD,
MS, FASE
esthesia's role is in helping with the
scheduling, moving of cases, and identifying
problem patients, advises Dr Grichnik.
" Someone who might have more
comorbidities than somebody else may
need to be done at a specific time in
the day with a specific anesthesia provider.
This mitigates the risk of having a
controversy at the beginning of the day
on the actual coverage for a patient, "
she adds.
ASCs should also specify what they
want in terms of the number of rooms
covered, hours of service, and duration
of coverage in terms of postanesthesia
care, she notes.
The contract may have a salary guarantee
for a certain amount of work at
a given facility. Is the anesthesia group
expected to start five rooms every morning
at 7 am, or are they contracting to
staff only three rooms? " If I need to hire
three CRNAs to work in three different
rooms, I know what the expectations
are, and I'm not scrambling around to
provide coverage, " says Dr Shapiro.
Find out how many days per week a
per diem anesthesiologist will work and
in how many ORs-and make sure that
language is specified in the contract.
" You have to build a model for what
that's going to look like so you know
that you have coverage for all the rooms
on the days you need them, " adds Dr
Miller.
Other financial considerations
The anesthesia provider's payer network
should also align with the ASC. State
www.ormanager.com
that in the contract, says Piotrowski.
" You don't want a patient to come to
your center who is in network with their
commercial payer; the surgeon is in network,
but the anesthesia group is not
in network, and so the patient gets a
surprise bill, " she says.
ASCs under new consumer billing
protections may be responsible for providing
uninsured and self-pay patients
with a good faith estimate. " That is a
different nuance than what we've dealt
with in the past. Working with your anesthesia
group on what may need to
be disclosed to patients is important, "
advises Piotrowski.
If the center agrees to provide initial
subsidies to the anesthesia provider,
your contract should have an end
point for when that will cease to exist,
she adds. This is especially true for
an ASC startup. " Once you're up and
running, hopefully it makes financial
sense for the center to drop those subsidies, "
she says. " And financially, it
makes sense for the anesthesia group
because they're getting the volume that
they need to sufficiently cover their expenses. "
Examine
staffing model, data
Be choosy in your contract models, Dr
Miller continues. Compare and contrast;
look at RFPs from different types of providers;
examine what the clinical coverage
and cost would look like for different
models. And be cautious about
low bidders because they might have
trouble recruiting anesthesiology staff
or may not have the extra resources to
cover what is needed, Dr Miller adds.
Understanding the ASC's staffing
model needs is important, but so is
understanding the data. Many ASCs and
hospitals do not take the time to look
through the details when drafting a contract.
" They'll just say, 'We need more
coverage,' " he says.
Continued on page 34
OR Manager | Nov/Dec 2022 33
https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills
https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills
http://www.ormanager.com
OR Manager November December 2022
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