How to survive case rates and global payments

The following suggestions can be helpful when working against the financial effects of case rates, reimbursement experts say:

• Carefully analyze your average cost per procedure and negotiate case rates that at minimum cover your allocated costs.

• Set time limits of less than two years on case rates contracts, and review them regularly.

• Renegotiate contracts based on technological upgrades and advancements.

• Carve out extremely expensive but low-volume procedures such as nuclear medicine that won’t be financially viable under a case rate.

• Determine your payer’s ability to issue checks accurately and regularly under case rates using present technology.

• Negotiate separate arrangements with multiple surgeries that are specific and account for all services.

• Look at the full spectrum of services being negotiated, and offset expected losses from some procedures with carveouts on others.

• Don’t flatly accept the Medicare ambulatory surgery center rate without negotiating a higher rate.