What if your ASC could see problems weeks before they hit your bank account? We dig into a practical playbook for turning raw data into clear decisions, from daily flash reports that act like a heartbeat to monthly benchmarks that expose where performance drifts and why. Instead of waiting for cash-basis financials to tell a late story, we focus on questions that move leaders to action: Where did payer mix shift? Which referrals slowed? Are we prioritizing the right cases at capacity? And are our fee schedules quietly capping revenue?
We share a simple, powerful benchmark strategy: index everything to Medicare. With that lens, a steady month of cases can still produce a revenue dip if Medicaid volume rises or a commercial contract underperforms. Using NPIs to track referral sources brings transparency to relationships, helping you target outreach when a group’s volume fades. Then we layer in forecasting: take the last 90–180 days, project cash forward, incorporate known inflows and takebacks, and set thresholds so partner distributions and capital decisions stop being guesses and start being planned.
Revenue cycle details matter. Patient liability collection should approach 95% of allowable, and the fastest wins often come from pre-surgical estimates, up-front collection workflows, and early-out strategies. Denials and zero-pay encounters can reveal coding issues or outdated charge masters; many groups unknowingly bill below allowable after Medicare updates. On profitability, we break down incremental contribution by service and payer to guide site-of-service choices and give you real leverage in payer negotiations. The outcome is a lean, repeatable reporting cadence that matches daily triage, weekly initiatives, and monthly strategy—keeping your data working for you, not the other way around.
If this playbook sparks ideas, follow the show, share it with a colleague, and leave a quick review. Your feedback helps us bring sharper tools and real-world examples to every episode.
Guest: Jason Crosby, VP Network Integration & Strategic Planning
Jason currently serves as the Vice President of Strategic Planning & Network Integration for Strategic Healthcare Partners (SHP) of Savannah, GA, with whom he has been employed for 13 years. With SHP, he oversees the Clinically Integrated Network activity, as well as the Business Development and Strategic Planning function.
Prior to joining SHP, Jason served as Finance Director for Georgia Emergency Associates, Decision Support Manager at Memorial Health, and as a Finance Lead with Gulfstream Aerospace.
Guest: Aaron Henry, Data Manager & IT Strategist
Aaron Henry has worked with SHP since 2019 as the Data Manager and all around Quality Payment Program expert. In 2021, his role expanded to include IT Strategy to help SHP navigate the changing IT landscape in a post-COVID workplace.
Prior to working at SHP, Aaron worked in various private practices starting in 2008, where he typically held dual roles as both the Health IT Administrator and Meaningful Use/PQRS Manager, and in 2015 he moved to the Savannah area to oversee the Quality Payment Program for a private practice.
Every year, since coming to SHP, Aaron has provided a webinar series updating QPP eligible practices on the proposed & final rule changes coming to QPP (recordings of which can be found on the SHP website).
Transcript
SPEAKER_03:
Hey everyone, welcome back to Beyond the Stethoscope, the Strategic Healthcare Partners podcast. I’m Jason Crosby, and I’m joined by my esteemed partner as usual, Aaron Henry. Aaron, how are you, bud?
SPEAKER_01:
I’m doing pretty good, Jason. A little tired, but having a 14-month-old does that to you. But hey, I’m excited to be here. It’s been a few weeks since our last podcast. Speaking of just to remind everybody, we’re doing things a little bit different this. Okay, well, uh happy recapping some of the great webinars that we’ve had and giving you an opportunity to dive a little bit deeper into the gobble gobble. So our most recent one was data analytics through decisions reporting, which lots of great, very insightful information was to be found.
SPEAKER_03:
Yeah, totally agree, Aaron. In fact, we work for all ASCs just like we work with various physician practices and hospitals. And at the crux of what we do is a lot of analytics. And so we came to realize just how much of a treasure trove or gold mine of data that our ASCs actually sit on. But as usual, sometimes you don’t know what to do with the data once you’ve got it, right? And what we’ll hear updates, I’ve seen all of this in Thanksgiving. I’ve done it recently and turned it into a webinar where they’ll unpack all the big ideas and real-world examples that many of us need that lead our ASCs. And so really good information on not just the data, but the story behind the data.
SPEAKER_01:
And before you switch us off and you go, I’m not an ASC, or look, I think there’s plenty that other medical practices and hospitals can glean from this information too. This is not ASC specific, although we talk a lot about ASCs. Obviously, that was the primary focus, but I don’t want to scare you away from this episode by any means. So with that, let’s jump into the first big theme that Mike Scribner laid out at the very beginning: the data gap.
SPEAKER_02:
Those that are born out of independent physician practices tend to be pretty skinny in how they are administratively run. Thus, a lot of times there’s not a CFO, there’s not a lot of in-house analyst support. Um, so there tends to be a ton of data that’s available within all the systems that are out there, but there’s this gap between this mass of data that’s available and what kind of typically gets turned into decision-making tools within the practice. The other problem that we tend to see is that we’re in this position a lot where because a lot of y’all run from cash-based accounting, and so you’re looking at the cash-based income statement, and the doctors are saying, I’m working as hard as I used to. However, our bottom line and what I’m able to draw out of the ASC side is lower, and or the practice side, either one, and it’s lower. And it the problem is that the financial statements, as reported cash basis-wise, tend to be a lagging indicator for almost all the problems that you’d have. You got a revenue cycle problem, a volume slowdown, some kind of cash flow interruption, payer mix has shifted, and you don’t see it in the month that it occurs or then month after it occurs. You see it when the collections slow down later on. So you’re in this position where, or we’re in this position, if we get drawn in on it, where the question is I think I don’t know for sure, but I think volume is basically the same, but cash is down by 20% over the last 60 days. What’s happened? And that’s a accrual-based financials probably would have helped with that B. That’s a lot of the issues with running financially with the barometer being the cash basis financials. Our typical question as we’re starting into this.
SPEAKER_03:
So, as you heard there, Mike, obviously that in sugar coat it, right? A lot of ASCs, they’re flying blind. We just mentioned there’s a lot of data, not sure how to use it, but at the same time, not sure how to extract, what to extract, which tools to use, which a lot of times they do not have. A lot of times they don’t have necessarily the people or the resources either. So it kind of leads the question of if you’re collecting the data every day but not using it, then what’s the point? What kind of time are you wasting by going about extracting it, but then not able to interpret at the same time?
SPEAKER_01:
I think this is a bigger problem specifically for those physician-owned centers where they don’t necessarily have a big team. They don’t have, say, a CFO or an analyst, or they do have a CFO who’s also one of the providers. All I end up is a mountain of spreadsheets and just a wish and a prayer that the cash flow is staying positive. But hope is not a strategy, not for ASCs, not for hospitals, not for anybody.
SPEAKER_03:
Yeah. And as you’re about to hear as well, Mike and I’ll will touch on cash-based financial, cash-based accounting, right? And so is that how much of an advantage can that be, or actually a disadvantage while you’re trying to steal the ship? Wouldn’t you rather have the radar, if you will, while steering it?
SPEAKER_01:
It’s about thinking about what’s ahead of you in addition to understanding what’s behind, but you can’t drive by looking in the rearview mirror. You’re gonna smash into a wall. So this is where those decision support tools really come into play. But how do we start making that shift? That gives us the answer.
SPEAKER_02:
Our typical question as we’re starting into this is as I’ll get into the next couple of slides, is not like what will the system produce. It’s what information do you need and what questions go not very well answered or not answered from a specific data points underneath it. And then so, like that last point, um, we run into a lot of time where there’s a data point that’s available, but there’s not a care there’s not a comparison point to it. So our mantra internally is that all data has to have some kind of a comparison point, either its own trend, a benchmark, something in order to determine whether or not it’s good or bad. It’s not and the the one that I we tend to throw under the buff a lot is like net net to gross, net collections to gross revenue is 32% a good number. Very hard to tell unless you’re looking at your own trend or you know what you’re charging as a percentage Medicare and you have a methodology to tie that back to something to tell you whether or not you’re successful or not. And so it’s those are very hard to do.
SPEAKER_03:
So, Aaron, as you heard there, Mike’s advice on how to go about gathering and interpreting such data. Don’t ask what the system can produce. Ask what you need to ask what you need to know, right? And so let me ask you that. You’re in the analytics group. When was the last time you looked at a report and thought, you know what? This time is it tells me exactly what I need to act on. Not too frequent, is it?
SPEAKER_01:
No, it’s not. And I kept thinking, boy, this sure sounds a lot like that famous JFK quote. And in some ways, that’s what we’re looking at here, right? So, hey, why is the data telling me this? And what do I need to do about it? So, why in this case, like, why is cash down 20%, but our volume is staying the same? That’s the sort of questions that you need to ask of the data, and it needs to be able to tell you the answers.
SPEAKER_03:
Yeah, and another point he hit on that I found interesting, regardless of the data points you’re looking at or what context, is how do you know if it’s good or bad, right? There’s got to be a comparison point. We look at that in our personal lives, it can be your lab results or something along those lines. How do you know something is trending well, not trending well, good or bad or another? And he touched on the net collection rate, for example. Are you doing well or aren’t you? You don’t really know unless you have that benchmark. And I found that to be a good point that might brought up.
SPEAKER_01:
You bring up the example of lab results. I think everybody listening has gone to the doctor and you get your lab results back in, and it’s either within spec or outside of spec. There is that benchmark, there is that baseline of what is healthy and you know what you should be. You neither want to be too high or too low. The analogy starts to break down for sure. But I think we can all understand that when our cholesterol is creeping up too high, maybe we need to start having less maple syrup on our pancakes, you know. But whatever the case is, we need to be changing something in our diet. And the same goes in our business. And so, where do you get these benchmarks from? Like in the lab, they have their benchmarks, they have what their normals are, it’s peer-reviewed, it’s understood. So, where do you get those that data? Is it your own benchmarks? There are definitely a lot of companies out there. Medicare has its own index. Context is king in this case.
SPEAKER_03:
Yeah, yeah. So far, we’ve heard from Mike and Janie about the importance of knowing why you’re pulling the data, what to pull, how to interpret it. We just heard about benchmarks. Now we’re gonna pivot to the next step of trending, cadence, timing. How often do you need the data? So the daily kind of reporting, weekly, monthly. From that, you start getting into trends. So we’re gonna expand a little bit on these first couple of segments you heard with Mike’s point here about cadence.
SPEAKER_02:
I get this is gonna feel like a lot of overkill, but when we sort of design, again, a decision support function for folks, whether that’s hospital, ASC, practice, what have you, the question tends to be we what do you need to know daily? What do you need to know weekly, monthly? And then what do you need to know more farther out? We just need to reset your understanding of it, and then what’s ad hoc that you need available when you need it, but you just don’t tend to know exactly when you need it or when the situation might arise for it. And so to put some, you know, just a couple of examples with these, from a cash flow perspective, we I’ll go over a slide or two that from a that a daily cash flow mechanism to understand where that where we stand with the ins and outs of that. That feels like something you would want to know daily. Yeah, it’s a bit of a pain in the butt to pull together and maybe you only want it weekly, but that information might be helpful to know. A fairly frequent clip from a revenue cycle perspective, where we are versus benchmarks. That feels like a monthly kind of analysis and where you update your initiatives and put some targets with that and keep that rolling forward. And I won’t go through all these, but the the point is that the replica being able to replicate the key reports in some kind of cadence that goes along with the with the decisions that you’re making around all of it, it needs to that the reporting needs to match that cadence. For example, if you’re halfway through the month and you know that you’re way off of the cash target for the month, then what information do you need to know what’s going wrong for you to do something about that? And that’s what this is is intended to at least show examples of.
SPEAKER_01:
Mike talked about matching your reporting cadence to your decision making. So ask yourself, what do I need to know daily, weekly, monthly? So think about it from a budgeting standpoint in your own life. How much money do I need to have today to go to the grocery store? But overall, over the week, how much money am I going to be bringing in monthly, et cetera, paying all the bills and that sort of thing? So think about it from that standpoint.
SPEAKER_03:
And we all log into portals now. It doesn’t matter the environment personally or coming from the health system background. There were daily reports we would generate, weekly, monthly. You heard Mike talk touch on the daily flash report. That stood out. And it’s it feels like your ASC’s heartbeat, right? You’re tracking all the key data elements so you know where things stand on a daily basis. So every morning you come in, you look at the report, you’re able to see the cash flow, the charges, AR days, volume. It’s all set up. And that shouldn’t take but a few minutes. After you’re used to looking at it, those daily reports, you know exactly what you’re looking at and you’re moving on in just a minute or two. But it gives you that real, up-to-date pulse of the day of your practice.
SPEAKER_01:
Yeah. So let me ask you this, Jason. If you were bleeding out, would you wait a month to go see your doctor, or would you want to stop that bleeding right away? Again, same sort of deal. You want to find out right away if you have a major problem. You don’t want to be 30 days behind understanding that you have a problem. You need to stop that bleeding now. You need to address the root cause as soon as you can.
SPEAKER_03:
Yeah, exactly. It’s like checking your vinyls. You mentioned you don’t wait for your annual physical, you want to know if something’s wrong, you monitor it daily. And over time, we’ve seen that report again, whether it’s ASC or hospital, you start getting used to knowing, okay, on Mondays or Tuesdays, we can anticipate cash flow lagging because of the weekend, things of that nature. So another great point by Mike there.
SPEAKER_01:
A fun fact if you don’t step on the scale, you don’t actually increase in weight. Just thought I would drop that little knowledge bomb there. But at the end of the day, having these tools is going to help you better predict the most important line in your financials, and that’s the bottom line. And so you need to know what that is. I think everybody, whenever you picked up any kind of financial report, it could be pages and pages. Where’s everybody flipping to? They’re flipping to the last page. They want to see what is that last line, how much money is in my bank account at the end of close, at the end of day. That’s important. And you need to try to be able to predict that. And these are the tools that Mike was talking about that can help you get there. So, speaking of getting there, let’s talk about the forecasting.
SPEAKER_02:
One of the things that kind of tends to is an extension of the point I was bringing up before, that the doctors getting them to understand where the cash flow sits, when distributions might be able to be done, and being able to project that out without just waiting for financials to occur month after month and then just guess at it at the end can be done. And so the point of this is what if you took your cash flow over the net last 90 to 180 days and projected it forward and then layered into that the larger payments that you know you have coming with, you know, take backs, inflows, all that. And if you push that out far enough, you can predict when there’s gonna be, you know, when there’s gonna be money for a distribution, when you might be going the other way and you might need to pull down on the LLC and make that not a we’re in this position, you gotta make payroll, and so doctors, we need funding right now. It’s to be able to project that out ahead of time and come up with mins and maxes around all that to give some heads up to it, as well as keep tabs on it yourself to know what’s going on. And again, it feels like a pain in the butt. Once it’s set up, the daily version of it is fairly straightforward. You’re only updating this maybe once a month. And so it’s just a matter of another methodology, been able to keep up with it a little bit better.
SPEAKER_03:
So first few segments, we’ve worked up from gathering data, benchmarking to cadence and frequency. We just heard from like we switched over to cash flow. Well, now a bigger pulse check of your practice than checking your cash flow, right? So in that instance, using the historical cash flow, whether it’s 90 or 100 days, a lot of people use 90, forecasting future distribution. If you do that personally, why would you not do it on your ASC here? So here’s a question for you: Are you planning your cash flow or are you just cleaning your eyes and hoping it works out? I don’t know about you, but if I’m watching that, I’m gonna be looking at it pretty consistently.
SPEAKER_01:
There’s something to be said by flying by the seat of your pants, but it doesn’t always work out. In fact, I’d say most of the time it doesn’t. Forecasting is going to allow you to really control the situation here. It’s everything from distributions to your partners, what sort of capital investments are you going to be able to do, staffing decisions, all of that becomes strategic value to you. So you’re now maximizing your dollar. It doesn’t make sense to run out and buy a new CT scanner if you’re not doing CTs. So take a look at that and being able to better understand and spend your capital in a wise manner so you get it back over time.
SPEAKER_03:
That’s right. That’s right. You had a whole nother point of kind of peeling the underback behind issues, right? If you’re seeing cash flow not making sense, do you have a volume issue? Do you have a scheduling issue, or what you’re going to hear up next that we often find is you might have some underlying revenue cycle issues. So it’s just another report that acts like a layer, if you will, to give you that radar of what’s going on. But other things happening underneath. All right. So as you just heard there, we went to cash flow review, right? So Mike talked a lot about historical cash flow, 90, 100 days, whatever your progress may be, most usually using 90 to forecast all those cash flow distributions. Not only are you trying to look at where cash flow might be, but the underlying issues that may sit within that. So the important question: are you actually watching your cash flow, or are you just hoping it works out?
SPEAKER_01:
Flying by the seat of your pants works out sometimes, but it’s not a good strategy. At a minimum, forecasting is going to allow you to take control. It allows you to take control of things like partner distributions, what capital investments you’re going to do, staffing decisions, all of those become important key strategic factors that you can plan for. Think about the capital improvements. Does it make sense to invest in equipment if you’re not really doing many of those procedures? So this allows you to be more strategic.
SPEAKER_03:
Yeah. Good point. Good point. And not only that, but help finding other underlying issues as we were just talking about. So do you want to lead to the issue or kind of react to the issues with the cash flow statement? You get that good basis, a good foundation that you can start peeling that onion back and realizing do I have some contracting issues, volume issues, or as you’re about to hear from Janie, potential revenue cycle issues. So let’s listen to the segment here by Janie on revenue cycle and benchmarking.
SPEAKER_00:
If you’re going to benchmark, we have to have some sort of target. And for most practices, some specialties are a little bit different, but indexing to Medicare in some mechanisms should give us a sense of kind of the overall performance. We don’t want to be paid sub-Medicare, but trying to match up each and every single service that we deliver to an actual Medicare reimbursement methodology can be very cumbersome. So our method of doing that is a matter of indexing. So you know, to walk through sort of the quick math of that, if Medicare pays us 50 cents for whatever we’re doing and Blue Cross is paying us 75 cents, then we would say we’re getting 150% of Medicare for Blue Cross. And so that’s going to give us that benchmark because our charges are consistent, our reimbursement should be relatively consistent. Our patient mix and the services that we’re delivering should be in a lot of cases very consistent. Of course, all of those things can change it and can skew it a little bit. So we have to know our book of what we’re delivering.
SPEAKER_01:
Now that was, of course, Janie. She took control of the situation and showed us how to benchmark payers using Medicare indexing. Again, going back to that point about what are our thresholds here? What is good cholesterol? What is bad cholesterol? And looking at things like Blue Cross, which is typically 150% of Medicare. So here’s the thought Do you know what your payers are really paying you compared to Medicare? So that’s, I think, a question everybody needs to be asking themselves. Use Medicare as your benchmark.
SPEAKER_03:
Yeah. Again, you guys are starting to hear a theme of you’ve got good data. What do you want to tell you? How do you know it’s good? The benchmark knows if you just sit there and the benchmark in this case being commonly being Medicare. Those again, practice hospital ASE side, it doesn’t matter. But she also referenced, okay, how do I extract which one of my filters for my extract the data? And the preference being we always use data service versus transaction dates. Because you just have that timing of when items are posted. So why not eliminate that concern, pull off a data service, and then therefore you got a consistent filter built in?
SPEAKER_01:
From a reporting standpoint, and I do a lot of reporting. It is easier to report off a transaction date. Your data stays relatively static, it’s less data to pull. But are you really getting the full picture? It is a far better picture of what’s happening within your organization if you’re doing by service state. So just bear that in mind. When you’re pulling your reports, pull it by service date. Yeah, it means you have to pull for a longer period of time. Your reports might be larger, a little harder to manage, but it’s worth it in the end. That’s right.
SPEAKER_03:
That’s right. And so let’s pivot a little bit. We talk about tracking, in this case, resolved charges, right? So what’s been paid, what’s been denied, what’s sitting out there in that unknown bucket that we hate that still sits a large opportunity for us, which brings us to that next layer of reviews. We all use it, and that’s in the payer mix realm. So let’s listen to Janie Mike talk about pair mixes and referral sources.
SPEAKER_02:
The next few slides, we’re thinking less revenue cycle and more kind of growth-oriented within the practice. And there’s multiple ways to look at this. Janie’s going to talk in a minute about referral source reporting and getting at our key referral sources and ferreting out and putting some transparency on that. But to back up before that, the this you know, we tend to spend a lot of time looking at the parametric adjustments in pair mix over time. And a lot of times it’s just ratifying that things are basically the same. But because there are such large swings between the various categories, like in the way we have it displayed here, let’s take it all and let’s index it to Medicare. Medicare is at 100%, Medicare Advantage will be at 100 to 105%, Medicaid for an ASC will be 60, 70 of Medicare, and so it tends to be a third less reimbursed on the ASE side, maybe only 10 to 15 on the MD side, but way less on this side. Commercial can be anywhere from 30 to 100% more, so call it 130 to 200% of Medicare. And so it’s wildly different. And then HIX tends to bell curve around 30, 40, 50% better than Medicare. So 130 to 150 Medicare.
SPEAKER_00:
And so then who is driving those revenue shifts and how can you have some handle on what’s happening there? This is looking at our new patient referrals coming into the practice. Sometimes we get really good information on this on the ASC side as well. Depends a lot on what data you cap data you capture. Some practices do a really fantastic job of it. My personal bin, I’ll make a plug for putting in NPIs because those can be cross-walked and you can get back to individual physicians and kind of group practices. Had a practice before, put in referral source is the billboard on 17. Not super helpful in figuring out where your referrals are coming from. But if you want to make sure where your marketing dollars are going, that can be helpful there, I guess. What we’re trying to figure out is are there groups that have been referring to us and our downturns in volume are? Is this a physician relationship? So group one, we’ve got some great referrals here, and then all of a sudden we’re trending further and further down. This is probably an incomplete quarter, so we’ll pause on that. But what’s happened? Is that something that’s worth our practice manager reaching out? Did we have a doctor retire? Is that is group one now a smaller practice? And where are their patients going if they’ve dropped them from that versus some others? Overall, we’ve got some downturns, but wanting to keep a finger on the pulse of who’s sending us things because that’s ultimately going to be the lifeblood of the ASC.
SPEAKER_03:
Again, reviewing the data, pulling it back. If even if when your volume is consistent, nothing is jumping out to you, that shift in payor mix will definitely jump out to you, right? It’s gonna wreak havoc on your revenue and you’re gonna know it pretty quickly. Again, going back to projections and benchmarking and knowing where things should stand. So if Medicaid’s paying 70% of Medicare and your commercials are in the upper 100, 160, 170%. How has that changed now that you’re going back and looking at data? What’s it saying today or lately?
SPEAKER_01:
Exactly right. And think of it this way, right? The this is crazy. This kind of breaks my brain coming from the retail world. You may be busier than you were before, but your revenue is dropping. All because your parametic shifted, right? You could be shifting and doing more Medicaid patients, for example, which is the 60, 70% of Medicare, and you’re doing more cases than you’re ever doing before. But if your commercial payers are paying$13,200, like boy, you got to do three or four Medicaid patients to equal one commercial. So you may be busier than you ever thought possible, and yet your revenue is still falling.
SPEAKER_03:
Yeah. And in this day and age, too, when payers are coming into the market, they’re coming out of the market so quickly, and ebbs and flows of it. You’ve got different networks evolving. It’s not a stagnant of a line item on your reports as it used to be. You knew payer mix. Now it’s going to ebb and flow. So it’s really important to keep track of. Another item that Jamie touched on, the pivot that she referred to is referral source. We always look at this, especially without migration type pattern. So another important element that Jamie touched on was referrals. You and you do this for quite a bit for us, Aaron, pulling NPI type data. And what we’re trying to do again is seeing who sends what where, basically.
SPEAKER_01:
Yeah. It is really important. And I think most EHRs do an okay job of tracking this, but I think most clinics don’t do a good job tracking it. Instead, they’re putting things in saw a billboard or Googled it. That’s not useful information. What is useful information is what providers are sending you patients, right? At the end of the day, that’s more important. So if a provider stops sending you patients, do you know why? Did they retire? Did they move practices? Or were they dissatisfied with patient outcomes coming from your ASC? All of those things are conversation starters, but you only get that information if you’re collecting that information. So if you’re not sure if you are, or if your EHR supports it, I’d certainly find out and get right on that, or find some mechanism maybe outside of your EHR if it’s if it’s not built in. It’s important to know.
SPEAKER_03:
Absolutely. And once you know who’s referring what, it’s a great time to go have that conversation with that other practice facility about how you can do more with them, build the relationship, become more of a referral source. And on the flip side, who’s not referring patients to you that you think we’re friends of the family? It allows you to have that conversation with concrete data versus just a feel of the volume, right? So another important data point brought up Pajani, and then going into profitability. A lot of times you can do profitability by service by referral source, whatever the case may be. But look, she’s going to touch on more here, her or Mike, both. So let’s listen to the segment here.
SPEAKER_00:
So this first version that we’re going to look at is our a litany of services that we’re rendering, what are average cost of implants? And this is all very rolled up. But what is the average incremental contribution to the facility of doing these sort of services? And so if we’ve been doing this and we’re seeking to project out what cases do I already have on the books, what cases do I anticipate? What is that going to do to my profitability overall for the group? Really a neat way of looking at it. Are these, are these perhaps cases we might need to consider shifting to a hospital so that they may have better reimbursement, they may have better better implant negotiations, but at the very least, we’re not losing money on the service. Or is this very minimal compared to some of our other profit lines worth keeping our physicians happy? A lot of physicians prefer to work in the ASC because of the convenience, the ability to control kind of their environment and their scheduling. But letting Dr. A know these aren’t really great cases for us to be doing here and they’re costing us money is worth a discussion, especially as you get into some of those other dialogues about draws and how they’re seeing profitability and how they’re seeing things produce revenue for them into individually.
SPEAKER_01:
Profitability analysis was yet another highlight. They showed us how to assess incremental contributions by payer type and by service type. So here’s a real question for everybody listening: are all of your cases profitable? And do you know for sure?
SPEAKER_03:
It’s an important question, right? So not only that, if you’re at capacity and you need to decide which ones to prioritize, you’re obviously you want to prioritize those on the higher margin side. And maybe there are some that are actually better off at the hospital versus in your client. But how would you know that unless again you looked at such reports?
SPEAKER_01:
Yeah. And we now know this, thanks to all the transparency data, right? ASCs are only getting paid about 30, 35% of what hospitals are receiving for doing the same procedures. To maybe your more medically complex patients, those that might need a higher level of care anyway, they would do okay at an ASC, but they would do best at a hospital. And it’s a low profitability. I think the decision there is easy. Of course, we don’t want to compromise patient care. We’re not saying that at all. But what we are saying is that if a call needs to be made, they’re on the side of the higher profitability cases.
SPEAKER_03:
That’s right. And again, you’ve got now you’ve got more data points and which to go negotiate with. And so if we all see the same reports, ASCs have become traditionally more efficient, higher quality, less costly. And now that you got this internal data that goes along with this industry-wide trend, you’ve got a lot more ammo to go to negotiate on your contracts.
SPEAKER_01:
Oh, yeah. It’s all about the leverage. And making the most of your negotiation with your payers is huge. If you come into that room prepared, yeah, I would say 90% of the time the pair goes in, they slap their final and best offer down on the table, and they walk out smelling like roses, and you’re left holding the bag. But if you come in and you have your own spreadsheets, you have your own evidence, you have your own proof, man, that makes for a much different negotiation. I think a lot of people leave money on the table because they don’t come in armed with the data. So speaking of money left on the table, let’s not forget patient liability and denials.
SPEAKER_00:
Patient liability collections. And this is again, a lot of this is internal reporting that we’ve developed. Most systems provide some metric to allow you to see how you’re collecting on things. We choose to group these in kind of all of our self-pay patients after insurance, is how we’re looking at this particular cut. And what we’re looking at are the total charges month by month, again, date of service driven, what we estimate the final patient liability. So these are based on the discount percentages that we’re seeing, the what’s actually been adjudicated, what’s sitting there as we get into more current months. This is going to be some ratio of percentages to that to anticipate it. And what are we seeing as collected up front? Is it this portion is dated, is transaction based. So that we’re looking. Did we collect that while we had the patient in hand while they came to the ASC? Did we collect it before the surgery was scheduled? And we can see very real dollars dropping. Charges are down ever so slightly, but not enough to warrant that. These sections here that are in this bold italic are projections of where we think our final collections are going to be. And then this is really helping us try to identify where are the breakdowns in our process if things are changing. We’ve got some improvement in collections in our 30s, 60s, probably after first set of statements have gone out. Do we need to consider an early out vendor? Are we sending things to bad debt? But what are we projecting as our total completion? What are we projecting as our total patient cash collection and ultimately what amount of our total allowed? Because you spend a lot of time negotiating contracts and trying to get better contractual reimbursement. But if you don’t go after every penny that you’re due, then you’re leaving, you’ve done all that work on the front end, which is a very difficult work and very time consuming. But this is all due to poor place of service collections. The flip side of this is what are the things that are being paid at 100%? And again, we’re looking at no contractual adjustment. We’ve got either a full insurance payment for that, or the insurance has paid something and the rest of it is sitting in patient liability, which we may or may not collect, but is something going on with our charges? As Mike said earlier, net to gross charges can be a false metric. Contractuals are not, in my opinion, your enemy. We want to make sure that we have our charges high enough that we collect every portion, every penny of what is due to us in the very best way that we can. These items typically look at is there something going on with a with the fee schedule? Maybe the fee schedule has changed. We had back in not ASC specific, but again, a physician example. And that was when we had the large change in the Medicare physician fee schedule. I had a practice that was charging 125% of Medicare. And when those EMs went up, in some cases 25% close to 30%, they were actually charging less than their allowables. And so they were leaving$25 an encounter on the table. Again, worth reviewing if you’re not in a cycle of doing annual charge master reviews and making sure that you’re set at a good target or comparing that to your contract, worth at least taking a peek to see if there’s anything that’s happening. And then similarly, these are items where we can look at again the physician, the particular payer, and looking where we’re actually seeing. We collected every single penny of that. And why did that happen?
SPEAKER_03:
All right. So there we talked about patient collections. Again, a couple of segments ago, we were talking about how some of these reports were dovetailing into Rev cycle conditions and issues that you need to look at. Well, Janie again touched on a key element there with patient collections, right? So many ASCs, as she touched on, collect far less than they should. And those in practice in the hospitals, you probably want to say the same thing. With the target being that 95% of allowable amounts, the question then becomes if you’re not at that benchmark, again, another key word we keep hitting on, where are you? And what amount of money are you leaving on the table if you’re not looking at it in that way?
SPEAKER_01:
I need to find all these tables, the money’s being left on.
SPEAKER_03:
Used to be trees. I guess it’s tables now.
SPEAKER_01:
Yeah, I guess it’s tables. They were all cut down and turned into tables. Janie recommended using our projections or your projections to identify where the breakdowns are happening and considering early out vendors or collected collection agencies when needed.
SPEAKER_03:
So everybody listening to those denials are like the back of your hand, ins and outs of it. But zero pay encounters can actually reveal a whole nother set of issues that can dive into coding or outdated fee schedules, which of course, Aaron, in your word, you guys look in day in and day out. And of course, what we just touched on before payer behavior and trends. So another reason or way in which to look at the nials that Jamie touched on is what’s happening on the market with the payers.
SPEAKER_01:
Yeah, and like the example Jamie gives specifically about that practice that was missing out on EM reimbursements purely because they hadn’t updated their fee schedule. That’s money lost. I see it all the time. Practices, they send us their fee schedule, it hasn’t been updated since 2019, which folks hate to break it to you. That was the better part of a decade ago. It is time to update your fee schedules. It needs to be done annually.
SPEAKER_02:
One kind of closing comment is that we try real hard to have education not be like just trying to sell our services. We’re trying to put good information out for you guys to react to. And so I I hope this didn’t leave you with the impression that this is all a bridge too far and that all of these reports are just like I’d never be able to replicate that. Some of them with some effort, maybe building it the first time, maybe a little bit, but replicating it may not be that tough. Hopefully, we’ve left you with some ideas of reporting that you can do that might give a little bit more transparency over the revenue cycle cash flow, volume, et cetera, et cetera, that you can react to versus just being overwhelmed with the amount of data coming out of your system and not being able to turn it into something that assists decision making.
SPEAKER_00:
I would tack on to that. That while the reports that we’ve shown you are the ones that we develop internally to coalesce this information, most DMRs have some form of reporting module that should be intrinsic to that. And perhaps it’s just a matter of digging around in your system a little bit and seeing what data points you can get out. Because any data and any report monitoring is going to be better than.
SPEAKER_03:
All right. So just to recap, a lot of information. We get that. But so many points to hit on. I recently saw Aaron where I think it was in Becker’s, where they’re projecting the 10,000 or so ASCs there in the country. Revenue just in the next five years should go from about, I want to say 45 billion to about 60 billion. How? There’s obviously a lot of growth there, right? So there’s a lot to say when what’s the big picture? I think it’s quite a lot that we can’t get our hands around.
SPEAKER_01:
Yeah, no doubt. And really, this is about taking the data you already have in your system and turning it into a decision-making tool. Ask the questions of the data, benchmark all the things, everything, benchmark it. Align your reporting cadence to what makes sense for your organization. Figure out what you need to see daily, weekly, monthly, yearly. Figure that out. Sit down. It’s going to vary from practice to practice, organization to organization, no doubt. Now, there’s going to be some things that are pretty much the same across the board, but what is interest to you is going to change. And be willing to change your reporting cadence too as your organization grows. And finally, use the transparency data to your advantage. The data is just sitting out there. You just have to go get it. It takes a little bit of work, takes a lot of bit of work, actually. It’s something I do all the time. And not to pitch ourselves too hard, this is something SHP can do for you.
SPEAKER_03:
Yeah, good point. Don’t be afraid to ask. It’s no dumb question sort of approach when you’re talking about what data you should be polling, how, why, when, where, and that sort of thing. So, my my I guess summation of a question, I guess, at the very end is if your ASC indeed had all the data, you love your EMR, you love your practice management system, but have you ever asked, would you change anything when it comes to reporting? What are you not getting? What do you not know? Maybe that’s the question you should be asking.
SPEAKER_01:
Yeah, that’s a great question. And I think that’s a perfect place to leave it, Jason. Everyone, thank you for joining us for this recap. We know it was a lot. You can go to our YouTube channel, maybe where you’re watching this, and you can watch the whole 50-minute webinar there. Or go to our website, shplc.com. You can reach out to us if you have any questions, or you want us to help you with your reporting. We’re happy to help. And until next time, keep your data working for you, not the other way around. We’ll see you, Jason. Thanks, guys. Thanks, everybody.