4 Reasons Why Part IV: Improved Physician Reimbursement

physician reimbursement value and cost

With payers shifting physician reimbursement models, and effective but difficult to navigate regulatory changes, physicians and patients feel the squeeze more than any other participant in healthcare. Physicians safely moving procedures to their own office is a great way to refocus efforts on care, improve the financial health of a practice, and regain a sense of autonomy.

The site of service transformation began in 1970 when two physicians joined forces to open the first ambulatory surgery center (ASC). The ASC model was created to establish a high-quality, lower-cost alternative to inpatient hospital care for surgical services. It expanded further in the early 90s with the birth of Mobile Anesthesiologists in Chicago, providing anesthesia and consulting to grow safe, effective, affordable office-based surgical options.

Today, with an estimated 11,815 surgery centers in the United States, this lower-cost site of service has been a major source of investment. Patients, physicians, and health insurers have all benefited greatly from this cost-effective and patient-centric option. Today, the healthcare industry is experiencing another site of service boom, as insurance companies and physicians look for innovative ways to improve their bottom lines. Witnessing advancements in technology and medicine, insurance carriers realized that certain procedures were still excessive at a surgery center and that additional savings and greater patient satisfaction could be achieved by using the aforementioned approach of moving procedures to physician’s offices.

To further incentivize the use of ASCs and office-based surgical procedures, physician reimbursement rules have been updated to move routine procedures such as lithotripsy, colonoscopy, or balloon sinuplasty away from hospitals. Insurance carriers created the Site of Service Differential or Global Fee (see UHC’s fee structure here, and CMS’s Medicare rules here). This reimbursement model presents a unique revenue stream for physicians, especially for individuals in private practice where their sustainability and livelihood rests on what they can produce themselves. It also presents an opportunity for physicians with office-based surgical practices to separate themselves from the competition by providing a less stressful environment and lower patient cost alternative to hospitals and surgery centers.

Beyond the obvious financial incentives of doing in-office procedures, physicians will also always enjoy greater control over their schedules as scheduling delays and a limited number of operating rooms are no longer an issue, especially with a full service platform like Noble Anesthesia Partners in Texas. The result is a more efficient, streamlined calendar with no additional travel required. Physicians feel an added sense of independence when they have more control over how their time is spent and are empowered to make decisions in the best interest of their patients. 

Time is more valuable than any other resource today and this is no different for physicians. The office setting provides the most effective and productive environment in terms of ROI especially with adding office-based procedures to the mix. Moving procedures out of a hospital or ASC environment and into their office means that Doctors are investing in themselves and optimizing their time, which is essential to maintaining a long-term positive revenue stream and work-life balance.

This concludes our four part series. You can re-read the prior pieces here:

Part I Moving Procedures in-Office

Part II The Evolution of Office Healthcare Technology

Part III Changing Industry and Demographics

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