Develop and Sell A Bundled Price Surgery Program
July 15, 2019
St George, UT
Are You Missing Out on a Great Profitability Strategy?
Cash-pay surgery at bundled prices is a growing trend in the U.S. But it’s not only for consumers. Employers are very interested in contracting directly with hospitals and ASCs to contain costs. Learn how it works and what it takes to build and deploy a program outside of the Medicare model.
A growing number of U.S. hospitals and ASCs have been 1) hesitant to invest the effort to develop a cash pay surgery program; 2) worried that they’ll be taken advantage of if they negotiate bundled price surgery on the same “All Products” contracts that HMOs, PPOs and TPAs offer them; and 3) worried that the TPA, Medicare or PPOs and HMOs will see their case pay rates and not want to pay the usual and customary negotiated rates. Under most insurance-based pricing, Hospitals and ASCs are expected to negotiate contracts with a variety of payer types according to the payers’ terms and conditions. But this product is different.
Every hospital and ASC has the right to offer a different, separate product under its own unique terms and conditions. And that includes a cash-program and a bundled price surgery program that can be offered to group health plans sponsored by self-funded employers.
Insurance-based pricing causes providers to absorb various transactional expenses, such as revenue management costs, costs associated with payment delays and compliance-related expenses. The requirements and duties beyond direct patient care erode margins or advantages associated with the maximum negotiated fees. In some cases, the performance requirements to get the money you’ve earned taking care of patients can turn the value of the contract upside down.
Cash-pay pricing is (and should be) a different rate than the insurance-based price. The latter includes costs of labor intensity, payment delays and other administrative variables, while cash-pay prices only need to encompass the expenditure associated with collecting the cash and depositing it in the bank under the appropriate contractual terms and conditions. That won’t come on the third-party payor’s terms and conditions. Cash-pay /bundled pricing gives providers greater control over how their services are sold and excludes factors that influence price calculations, ultimately increasing the providers’ profit margin.
To protect their interests, hospitals and ASCs need their own contract form agreements with unique and enforceable terms and conditions, plus other documents and infrastructure development to operate the program successfully and profitably. This class covers all the points on the checklist and offers hospital and ASC executives and managers the practical tools, tips, and document outlines they need to be up and running in about 60 days’ time.
6 Learning Objectives:
- Learn how to design a cash pay surgery program featuring bundled surgical case rates
- Understand how to market to and attract cash-pay surgery patients from outside your local market area, including from Canada and outside North America.
- Learn which marketing strategies and tactics to use to attract self-funded employers, TPAs, and brokers & consultants who are motivated to find and adopt your solution
- Understand what’s involved in developing your program. All the steps from A-to-Z, including travel, hotel and ground services.
- Discover new options that exist to help consumers pay cash at the time of service without interest or credit bureau involvement
- Review a full set of the documents you’ll need to operate your program in an accredited healthcare facility and with a mix of employed and independent physicians in the community.
Who Should Attend:
- Hospital and Health system executives and managers
- ASC managers
- Critical access hospital executives
- Independent surgeons
- OR supervisors
- Admitting coordinators
- Revenue managers
- Business office managers
- Contract negotiators
- Marketing directors
- Business development directors and managers
- Surgery schedulers
Class size limited to 35 participants – Please register early to avoid disappointment. We expect teams will register for this class.
Course Materials Supplied:
PLEASE NOTE: All course materials are on a USB
- Course PowerPoint Slides
- Sample forms & tools
- Additional reading materials
What to Bring to Class:
- Laptop Computer – all class materials are supplied on a USB
- Sweater or light jacket
- Business cards
- Power supply for laptop and cell phone (power strips provided)
- Notebook or Writing Tablet
Meals & Refreshments:
- Breakfast (On Your Own)
- Coffee & Water
- Lunch (On Your Own)
- PM Snack & Refreshment
Because we don’t permit on-site registration. The event venue will be sent to you with your registration confirmation. Many of our venues are training centers, so be sure to choose a hotel nearby. Your registration confirmation will include several hotel options. Public transportation and ride-share availability are considered when we choose venues and course destinations.
Course hours are generally 9am – 4:30pm. Detailed information is supplied with course registration confirmation.
Refunds are available if you cancel your registration 20 days in advance, less a 15% administrative fee. Substitutes are always permitted.
The makeup of class registrants always varies. We don’t offer CEUs from any issuing organization, but we will provide whatever materials you may need to apply for credit from your professional society or association. We’ve yet to encounter a certifying body that has refused to grant credit for Maria Todd’s programs.