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EDITOR'S PAGE
profitable. Pretty radical, right?
"What's really radical about what we've done is that we've actually
shown the numbers," says Dr. Smith. "Some insurers love that our
prices are bundled. When we present a bill, it's an invoice with a number on it. That's it. There's no itemization. They don't care if we gave
Tylenol in the operating room.
"We told our surgeons that we're not going to take federal money in
this facility," adds Dr. Smith. "We're going to operate it like a business
and distribute money like a law firm."
Unless insurers are willing to pay the surgery center's website pricing
and do so in a timely fashion, the ASC simply bypasses them. "We do
deal with some third parties, but that's something we do reluctantly
and very short term. Long term, our goal is to become completely
cash-based. We're well on our way," says Dr. Smith. Currently, he says
10% to 15% of patients pay out of pocket and another 25% of business
comes from large self-insured companies.
The goal is to cut insurers entirely out of the reimbursement equation, to cater exclusively to self-insured companies and to private-pay
patients (see "Ready for the New Healthcare Consumer?" on page 10)
who shop online for surgery.
Dr. Smith quit Medicare and Medicaid cold turkey in 1994, tired of the
"abusive" reimbursements: $78 for a total knee arthroplasty and $285
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