Is your Hospital or ASC losing surgery cases because you don't offer cash pay surgery prices?
There’s been a lot of talk and movement towards Cash Pay Surgery prices. 83% of consumers, regardless of if they have insurance or not, use the internet to search reputations, feedback, and prices for cash pay surgery procedures.
CASH PAY SURGERY IS A “THING”
You don’t need to take our word for it! Search on Google for the term. Here’s what we got right now when we searched it:
About 66,200,000 results (0.49 seconds)
Then we searched Cash Pay Surgery USA, and here’s what we got back:
About 33,400,000 results (0.56 seconds)
The search engine results listed articles from many ASCs and hospitals, consumer publications, Modern Healthcare, self-help websites, and the top listing was from the Association of American Physicians and Surgeons. So yes, the time has come to deal with this revenue model and get up to speed and implement it at your hospital, clinic or ASC.
Which consumers shop for prices?
- Huge deductibles. Many people now have in-network deductibles as high as $6500-10,000 (for catastrophic plans) so the price they pay matters. Or, their in-network provider list is unacceptable and their out of network deductible and lower benefit level means that if they use their insurance out-of-network, it pays so little that they’d rather pay cash.
- People with funded HSAs are often willing to drive a little further, fly to a destination someplace else in the USA and have surgery and recuperate at the destination for a few days before driving or flying back home. They have freedom of choice and cash to spend. Will they spend it elsewhere?
- Those eligible for a tax deduction. If the surgery was for what they deem a medically-necessary reason (not strictly cosmetic), they get to take a tax deduction. As of 2019, if you are 65 years or older, you may continue to deduct total medical expenses that exceed 7.5 percent of your adjusted gross income through tax year 2016. If you are married and only one of you is age 65 or older, you may still deduct total medical expenses that exceed 7.5 percent of your adjusted gross income. For consumers under age 65, if they itemize deductions on Form 1040, Schedule A, the threshold for unreimbursed medical and dental expenses they paid for themselves, their spouse, and their dependents must exceed 10 percent of adjusted gross income before a deduction is permitted. Those unreimbursed medical and dental expenses can also include the hotel and travel expense to and from the care destination. If they go out of network, there may be zero coverage but they may actually pay less than the out of pocket costs to stay in network.
- Canadians and foreigners. Many places that offer public health for all come to the USA because their system doesn’t offer what they need, or there are long waits, or the service is not covered under the public health service program, or the services are not permitted or culturally acceptable (e.g., substance abuse rehab in some cultures, sex change operations, transplants, IVF, and more) and they need anonymity and privacy. Cash pay prices posted transparently on the internet afford them options they would not be able to discover otherwise.
- People with health expense sharing plans. Then there’s the new types of plans that are growing in use that go by the names of: “Health Care Sharing Ministries” (aka “Health Sharing Plans”) and “Association Health Plans”, or “AHP’s”, for short. Unfortunately, the impact of their growth could be devastating for everyone with health insurance. These are self pay cash patients. Period. There is no contract, there is no insurance. There IS a DISCLAIMER that reads as follows:
“This program is not an insurance company nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills.” They are also on the hunt for CASH PAY SURGERY prices that reward them and their sharing plan members with discounted pricing.
Are You Missing Out on all these Revenue opportunities?
Why?
Some months ago, we spoke with a marketing manager at a Denver, Colorado hospital that told us they didn’t want “self pay patients”. When she said it, she made this face that just showed her true disdain for people who pay their bills and are willing to pay for their surgery in full, in advance of the date of their pre-op consultation with the surgeon. Was she so prejudiced against ALL self-pay patients that her blinding prejudice replaced her common sense?
Industry research from many sources shows that the cost to collect from insurance plans and government programs (work comp, Medicare, Medicaid, VA, etc.) now consumes about 28% of revenues. That’s after the discount. 28% of net.
Other research widely quoted indicates that about 14% of claims are inappropriately denied by third-party payers and require additional work to bring in cash. Another report from the U.S. government states that of all the Medicare Advantage claims submitted by hospitals and doctors, 75% are wrongfully denied but only 1% are followed up. Perhaps the lady in Denver missed those articles. We wondered two things when we spoke with her:
- Was she aware of what it costs to “prefer” third-party payments over cash payments?
- Does her executive team know her opinions and do they concur? Who’s running that asylum anyway? The inmates?
Then there’s the recent RAND study that places Colorado 20th out of 25 states for highest relative commercial health care prices compared to Medicare. The analysis indicates that across the 25 states participating, prices paid to hospitals by private insurers in 2017 averaged 241% of what Medicare would have paid. Colorado is on the high-end of the spectrum with relative prices across both inpatient and outpatient services paid at 269% of Medicare. Outpatient services average 350% of Medicare in Colorado while inpatient services average 220% of Medicare. So maybe that’s why she doesn’t like self-pay patients.
Are You Ready to Start or Expand Your Cash Pay Surgery Program?
Maria K Todd, MHA PhD
In this MASTER CLASS WORKSHOP Maria Todd will teach no more than 35 healthcare executives and managers from hospitals and ASCs around the USA how to build cash pay surgery prices for every surgical procedure they decide to include.
Seats are already filling up. Reserve your place in this one day class now!
You’ll leave clalss with your unique CASH PAY PRICE CATALOG created and populated with several procedures and even allow for variations among implants and surgery time by surgeon.
You’ll return back to your offfice with these valuable course materials:
- A 10-page MODEL CASH PAY PRICING POLICY ($4500 value) that has all the citations of regulatory compliance with a nod to financial assistance policies, write offs and supported their commitments to furnish affordable care to patients and providing another payment option that may be more financially appropriate;
- A detailed CONSUMER CASH PAY FEE AGREEMENT TEMPLATE ($3500 value) that defines the acceptable payment forms, prohibition against credit card and cashier check chargebacks, dispute resolution, and exclusions for services outside the bundled case price (e.g. follow up care, intraoperative complications and required transfers, products liability for implants, the costs of follow up care, etc.);
- A MODEL SINGLE CASE AGREEMENT ($1500 value) template for use with non-contracted payers, employers, and other third-party payment sources.
- A MODEL DELEGATED CREDENTIALING AND PRIVILEGING ADDENDUM ($7500 value) that they could use with non-contracted health plans and employer self-funded health benefit programs for direct-with-employer contracting.
After nearly 40 years of consulting on cash pay surgery and medical travel program development, Maria Todd knows what you’ll need and its more than a price list. You need a marketable “product” to advertise to that 83% of the population who now shops for healthcare using the internet in search of affordability, transparent pricing and convenience online rather than calling a hundred hospitals and ASCs on the phone. Otherwise, you’ll be a best kept secret.
She also includes:
- A Model Independent Contractor Agreement Checklist ($300 value) to execute with collaborating Surgeons, Dentists, Anesthesiologists, CRNAs, and any others who are not “employed” by your organization. You must be clear with your “supply chain” vendors about what you’ll pay them, when you’ll pay them, and execute an Authorization to Bill on behalf of these providers, along with their agreement not to bill the patient directly for the same services. There must be a delineation for services included in the package price and services rendered, if any outside the package price, such as additional visits, ongoing telehealth support and tail coverage requirements in the event of a mishap or complaint within a statute of limitations. You can’t pay the independent contractors their fees at the end of the case if you don’t have payment in hand if they are not your employees. A basic independent contractor form agreement you use from a generic source won’t cover all that needs to be memorialized in this use case.
The value of the templates, checklists and other materials you bring back from class is many multiples the cost of the 7-hour course. But she doesn’t sell the templates without the training to use them.
Don't Arrive with a Blank Pad and a Pen!
To get the most benefit from this Master Class, Maria requests that you bring a laptop computer to class. Her courses are designed as “hands-on learning” experiences. Bring some example data from your hospital or ASC so that you can learn on your own real data rather than sample class data.
Don’t worry, you won’t be asked to share your proprietary data with the class!
Come with the data you’ll need to produce real results by the end of class. The data you’ll need to gather includes:
- Certain incremental costs per procedure (listed by CPT code) for facility overheads, supplies used, implant costs, anesthesia costs,
- Time averages per case by that surgeon for OR, Pre-op and PACU for each CPT code for which they chose to offer on a cash pay surgery price
- The surgeons and staff involved and their hourly cost
- Implants and prosthetics used by surgeon / by CPT code
- Their standard offer for how they defined their “episode of care”.
Maria provides a tool for use in class that you take home. During class, you’ll begin creating your price list of bundled surgical case rates. We’ll do several procedures in class, so that you have a chance to practice. Your confidential data is not intended to be shared among class participants.
The term Master Class has turned into a buzzword. But this class is the real deal! In a Master Class, students have a chance to work on their class materials and receive individual critiques and help from the instructor.
Once you create a few cash pay prices, you’ll feel very confident in your ability to structure your surgery case rates. You’ll return to your office ready to finish your price list in a matter of a few hours if you have more procedures to build out. You’ll take home the formulas that makes so much more sense than the Medicare Bundled Pricing program and mitigate financial risks.
What’s more, once you have these templates finalized, you’ll have a model to benchmark against for when TPAs and other networks offer their old-fashioned copy-paste PPO agreements that don’t fit the cash pay model. You’ll know exactly what to ask for in your red line pushback. And you won’t be taken advantage of, ever again!
This is Free Market Healthcare at its Finest
You set your rules, your inclusions and exclusion, your unique offers, your prices, your terms and conditions, and you determine if the patient is a good candidate to accept in your program. And you get paid in advance or on the day of service, in full. No billing, no collections, no insurance negotiations, no payment follow ups, no claims resubmissions, no second and third requests for medical records, no claims audits, no excuses, no contract analysis and negotiation expenses. Just cash. Up front. In full.
After all, when people fly to India or Thailand or Costa Rica or Mexico for surgery, they are expected to pay cash. And they do. And they pay for airfare for at least two people, and hotel accommodations, and restaurant food, and sightseeing or other activities to tolerance. Why not keep them right here in the USA?
Join the hundreds of hospitals and ASCs and private independent surgeons with surgical suites in their office who are listed on Google, Yelp, and other ratings platforms on the internet with 4.5+ stars or higher.
Are you on those lists? Should you be? Do you want to be? Help patients so grateful for the opportunity to save money, get the surgery they need to find a solution to their pain or medical problems or something cosmetic that’s bothered them for years. And if they are ready to pay the bill, isn’t that the sort of patient you want making inquiries and surgery bookings?
Marketing Your Cash Pay Surgery Prices and Program
That leads us to another topic Maria covers in her 7 hour MASTER CLASS WORKSHOP:
Marketing your cash pay surgery prices and program.
Many of the providers she helps were best kept secrets.
They didn’t know what to mention in their advertising, lacked confidence, or were afraid that their managed care plans will balk. So they said nothing. That won’t grow your cash pay surgery program.
Here are some pitfalls she’ll show you how to avoid:
- Risk of managed care problems. Before you can market a cash pay surgery program, you will need to know what to look for in your managed care agreements to make sure you aren’t going to give rise to a breach. So in the 7 hour class, I sent students home with a checklist so they could review their key managed care agreements to read the contract in this context of marketing cash pay surgery (and diagnostic testing) discounts.
- Writing up your descriptions of inclusions and exclusions, case by case, CPT by CPT. You must advertise clearly and unambiguously. There’s a right way and a wrong or ineffective way to advertise. But you must also address all touchpoints in your consumer fee agreement or memorandum. That means explaining what’s covered post-op, pre-op, what happens if there’s a complication that requires an interruption and transfer to ICU, who covers post-op follow up and complications, disclaimers for defective or recalled implants, etc.
- Another thing she covers is the use of CPT codes. CPT codes may be great for internal controls and invoicing and supplying cash receipts. But should you use them for marketing and advertising? The answer depends on your program. A CPT code comes with an official interpretation and often infers that your surgeon will include 90 days of post operative follow up care at no additional charge.
On the international scene, so many cash pay medical tourism sellers in the offer “asterisk pricing”. Their prices are meaningless and incomparable. What’s worse is they frequently charge Americans higher prices than their own citizens and visitors from other countries.
We all bleed red. Why do Americans get singled out for higher prices? Who knows! But they do it anyway all around the world. In Korea, this discrimination is protected by law!
- How to build your “program” instead of just a price list. Once you have the program, you’ll need a marketing and advertising strategy and tactical plan. So Maria share ideas for marketing and advertising that aligns with your brand. It isn’t a once size fits all strategy. If it was, you’d appear just the same as your competitor. That’s not logical.
- If your brand isn’t a cookie cutter of your competitor, your marketing and advertising messages won’t be either.
The tools and idea e-book Maria provides to class participants is something to take home and work out after class. Some consulting after class may be helpful. But Maria believes that most class participants are able to design the strategy, tactics and deploy without further assistance. They just need a set of rails and the information to know what to do and how. And that’s what she delivers in class.
Help With Marketing and Promotion? No problem!
We’ll market your services on SurgeryShopper.com if your hospital or ASC meets our criteria for participation.
SurgeryShopper.com coordinates inquiries from consumers and employers seeking cost containment solutions.
The staff and experts at SurgeryShopper.com help employers with all the moving parts from selecting candidate facilities and surgeons, to site inspections, to contract negotiations. Then, once their plan documents and details are implemented, we help them to coordinate patient movement and continuity of care, billing and provider fee settlement, and clinical and satisfaction outcomes measurement.
But for eligibility on SurgeryShopper.com’s database of pre-qualified, pre-inspected accredited providers you must have a “program” in place, not just a “price list”.
If all you have is prices, SurgeryShopper.com can’t add you to the network. Plain and simple. Pricing only positions you as a commodity. SurgeryShopper.com is an opportunity to compete. There’s no obligation to purchase consulting or training from Maria Todd, either. If you are ready and meet SurgeryShopper.com’s rigid criteria for inclusion, you’ll be invited to join the menu of providers. Any time you need to increase your cash pay surgery prices, you send them an email and the new price gets updated to the database. Boom. No hassles. Done.
With SurgeryShopper.com, there are no referral kickbacks, marketing commissions, or other obligations. Just give clients good care at affordable prices and anticipate their needs and offer them a total solution and everybody wins.
To work with employers, your program must include the offer of delegated credentialing so that plan fiduciaries can accelerate their consideration to use your services and meet their plan fiduciary obligations and get started right away. Maria will explain how that works in class.
What you offer in prices is your business. There are no fee schedules to agree to. You compete with the others across the USA . If they see your value and your destination is appealing, they refer patients to you. Some patients drive; others fly.
But all that is optional goodwill. You don’t have to be listed on SurgeryShopper’s website if you don’t want to. And it isn’t exclusive. Take the knowledge you gain in class and use it on any network you decide to join. This is just a little something extra if you decide it has value for you.
Financing for Cash Pay Surgeries
Another component of a CASH PAY SURGERY program can extend your reach to those who would love to pay cash and get the discount you offer, but they don’t have the cash at the time time they need it.
Maria teaches you about all the different “medical loan” programs out there. Some run credit checks and tie up credit limits and credit cards, others don’t run credit checks and keep the loan off patients’ credit reports and scores. Most loan money for use on surgery in the USA but not abroad. A few loan money to travel cross border for care. Most don’t. Maria Todd helps you avoid being the healthcare provider and becoming an unregulated and unauthorized “bank”. All that complexity! But it doesn’t end there.
Because you cannot advance cash to the doctors and other subcontractors for your program, if you don’t get paid up front, you add the cost and aggravation of bookkeeping to the mix. You’ll have to convince them to wait and share risk of non-payment, late payment and slow payment. That’s not what cash pay surgery is about. And the added expense of all the accounting and bookkeeping adds costs and overheads not calculated into the pricing.
Another thing many healthcare providers don’t know is that if you exceed 4 installments in a payment plan, you can cross the line on some FDIC regulations and expose yourself to liability for $750 per account in fines. It’s complicated. But Maria shares the details in this Master Class.
There’s far more to this than getting an authorization to debit or charge a card with credit card on file.
If you start taking installment plans for your cash pay surgeries, you will end up needing a contract that states all the disclosures you get in compliance with an FDIC regulated agreement. Pages and pages of fine print will scare the hell out of your patient. Outsource it to people in the highly-regulated field of loaning money and financing.
You do healthcare! Arm the patient with options they can research, decide and prequalify for funding. There are no recourse options, no credit check options, and so many other ways that money moves from the money tree in their back yard to your bank account.
Maria explains how to stay out of the process and the associated costs and aggravation and compliance exposures!
Learn how to prepare your clean claims and invoices and receipts for cash. Otherwise, your margins narrow.
When you are discounting your standard fees you want to preserve margins as much as possible and as simply as possibly. Keep it simple!
ARE YOU READY TO STOP LOSING CASES BECAUSE YOU AREN'T PREPARED?
If you are interested in establishing a cash pay surgery program for your hospital, ASC, rehab center, diagnostic testing service, or office-based surgery suite register for this MASTER CLASS WORKSHOP on August 28th in St George, Utah. Plan to bring the family and enjoy some time off and Labor Day weekend in and around the “Mighty 5” National Parks (Zion, Bryce Canyon, Capitol Reef, Canyonlands, and Arches), or in Las Vegas. St George is 112 miles north of Las Vegas Airport and easily accessible by rental car or shuttle service for about $25 each way. But book early as this is a popular week for family tourism in St George.