Practice Management
Spring 2024
by William Rabourn Jr.
Moving to global pricing requires careful planning and research because each practice or ASC is unique, even within the area it serves.
Owning an ophthalmic practice or ASC is challenging, especially when it comes to billing for cataract and refractive surgery. In addition to Medicare’s rules, there are also third-party payers that have different requirements on how much you can be reimbursed for specific procedures. Add to that the different technologies each practice uses and that some patients are comanaged, and it results in a complex maze that must be expertly navigated to ensure proper reimbursement for services.
From the patient’s perspective, this can be especially confusing and lead to mistrust and dissatisfaction with the overall experience. Some patients, instead of focusing on a positive outcome, may feel they are being “nickel and dimed” into a higher bill, which often leads to misunderstandings and negative perceptions.
What’s the solution?
So, how can this be avoided so that the patient has an overall seamless and positive experience? One solution that has been gaining traction in recent years is global pricing for the various components and options that make up cataract and refractive surgery, such as charging one price for all types of lifestyle lenses instead of separate pricing for each. This helps simplify billing so it’s easier to understand and communicate.
There are many advantages to global pricing, including improved administrative efficiency, streamlined billing processes, better financial planning and budgeting for your practice and ASC, and increased patient satisfaction due to greater cost certainty and a focus on the end result. This can lead to an overall competitive advantage in your market or at least provide a compelling benefit for potential patients to consider.
Implementing a new pricing structure
However, moving to global pricing requires careful planning and research because each practice or ASC is unique, even within the area it serves. The following are some tips for determining the right price for what your practice offers:
- Look at patient data.
- Include direct and indirect costs.
- Look at what competitors are charging.
- Categorize procedures.
- Be sure to include procedure-specific costs in the final price.
- Don’t forget value-based pricing.
- Clearly communicate with patients.
In addition to the above steps, be sure to clearly define exactly what is and isn’t included and communicate that to the patient before the procedure. Also mention that unforeseen complications might require additional follow-up care and fall outside the scope of the price being quoted. This way, you can help avoid any unexpected surprises.
Once a price has been defined, clearly educate patients on not only the medical aspect, but also the technology used. This will give them a better idea of why the price you are charging is justified and reasonable. Don’t forget to review your contracts with Medicare and third-party payers to ensure whatever pricing implemented falls within the guidelines outlined in those agreements.
Finally, implement the new pricing structure gradually and not all at once. Begin with the procedures your community needs the most and work from there. This will also provide you with a trial run to see if your pricing is what it should be or if adjustments need to be made.
Additional considerations
Moving to a global pricing structure may bring new patients through the door, but it may also turn off some who are not used to seeing the total cost of a procedure upfront. This can be overcome with proper education. Explaining what’s involved and the technology used will do much in helping to overcome objections. If you educate potential patients properly through marketing and in-person consultations, they will make the right decision.
However, before you begin the education process, make sure you have decided what media should be used and who the best person in your clinic is to conduct consultations. Printed information and/or a video are the most effective aids in educating potential patients on the process. Also, if you don’t have the staff in place to handle consultations and the administrative duties required, take the time to get the right people before launching this type of pricing structure and provide them with the proper training.
Financing options are something else to consider. Most people know that surgery is expensive, and for procedures that aren’t covered by a healthcare plan, financing options can make them more affordable.
Finally, periodically review your pricing structure to ensure it is competitive within your market and accurately reflects current costs.
There are many advantages to using a global pricing structure. It streamlines billing and administrative processes, provides patients with cost certainty, and helps provide your clinic with a competitive advantage. It’s proven successful in many U.S. markets and has shown to increase patient satisfaction. However, implementing this type of model requires careful planning and research. If done right, everyone benefits.
About the author
William Rabourn Jr.
Managing Principal
Medical Consulting Group
Springfield, Missouri
Contact
Rabourn: brabourn@medcgroup.com
