Orthopedic Surgeons and ASCs: Reduce Payment Delays and Improve Your Bottom Line

As a leading authority on cash pay program development, I wanted to share a few tips for reducing payment delays and improving bottom line performance

Managing the balancing act of patient care, prior authorizations, reimbursements delays, and contracted payer negotiations, and payer platform cash flow challenges that can jeopardize financial stability. I know this because I write the paychecks for staff to do all this every two weeks. It's painful!

Here's the pathway:

#Cashpaysurgery

Not only will you streamline operations and lower your costs, it is a direct pathway to accelerate cash and improved bottom line while transparently discounting prices and manipulating margins as you see fit.

Cash pay surgery offers several advantages to providers, patients, and most Fortune 1000 employers:

1. Immediate Payment: By offering transparent, up-front pricing for surgeries, providers can bypass all insurance reimbursement controls. Full payment is collected prior to service, which improves cash flow and reduces risk and costs to bill and collect. This can be up to 45% of the bloat in rendering care.

2. Simplified Pricing: Cash payment models allow ASCs and surgeons to establish clear, bundled pricing for procedures. These packages can include the surgeon’s fee, anesthesia, implants and hardware, take home meds, and facility costs (but can offer or include much, much more!). Eliminating variables and contingencies makes it easier to price services competitively while setting profitability on your terms. Fortune 1000 employers who are fed up with high "in network, negotiated prices" from their TPAs and ASOs will #redirect to you if you offer this option. They will pay in advance, authorization comes with the referral, and it doesn't matter if you are out of network or out of town. The savings are so compelling that they will pay the travel and ground support expenses as well.

3. Attracting a Loyal New Patient Base: Cash-pay models can attract self-paying patients, medical travel patients, self insured employers, and people with high-deductible insurance plans. Everyone values knowing exactly what they will pay. And these folks return when they require additional services. I just booked three repeat Canadian patients from last year this week alone. They booked for November 2024. That's $70,000 in revenue without doing anything special other than coordinating the cases which took me 20 minutes combined across all three because my infrastructure is built.

4. Reduced Administrative Overhead: Processing insurance claims, handling denials, and managing appeals require time and resources. With cash payments, administrative staffing costs plummet. Hourly compensation, worker’s compensation, desk space, phone extensions, computer software and hardware, postage, printing, printer cartridges, paper, credit card processing fees, costs associated with payer contract analysis and negotiation—all eliminated. Those dollars drop straight to your bottom line.

How Cash Payment Models Benefit Orthopedic Surgeons and ASCs

1. Faster Turnaround on Revenue: Funds are available immediately. Risk of nonpayment is eliminated.

2. Cost Transparency for Patients and Employers: Your upfront, all-inclusive pricing, gives patients and their employers the confidence to move forward with necessary care. They finance their care their way. You don’t need to be the bank and underwrite financing or manage payment plans which erodes your margins. Make a compelling case and they will redirect from all around the country. One little issue: hopefully you have an airport nearby and clean, modern hotels.

3. Focus on Patient Care: Surgeons foster stronger relationships with loyal patients leading to more referrals and repeat business. ASCs are the backdrop for the magic. Don't try to position the ASC for the headliner loyalty. Patients don't get it. And yes, I am aware of compliance issues. There are ways to get through this without bending compliance rules or flying too close to the sun, like Icarus. 'Ria no like singed wings!

4. Flexibility in Pricing and Services: Your price, your formula. Payers and TPAs no longer dictate your perceived value proposition. ASCs and orthopedic surgeons can expand their offerings in niche areas including robotic-assisted surgeries, capturing market share that might otherwise go untapped.

Strategies for Implementing a Cash Payment Option

1. Bundle Your Services: My new Bundlr software helps you build a simple pricing structure by bundling all costs associated with a procedure into one transparent fee. The software forces you to enter cost data leading to price integrity as long as you maintain the cost accounting accurately. If you keep accurate cost info, the software won't let you sell a surgery for less than it costs to provide. Want a demo? Just ask! Call 800-727-4160. We are authorizing 15 beta test accounts for up to 5 free pricing bundles, by CPT. If you have your costs in hand, you'll have your bundles in 10 minutes.

2. Educate Your Patients: Market your cash-pay options to uninsured, underinsured, sharing plan, and high-deductible plan patients. Cosmetic surgery patients will also benefit.

Case Study: A Success Story

Orthopedic surgeons and ASCs can implement cash-pay options with impressive results. For instance, an orthopedic surgery practice in the Southwest implemented a bundled, cash-pay model for robotic assisted joint replacements. Within the first year, the practice reduced its average accounts receivable by 60% and saw a 30% increase in patient volume due to its straightforward, transparent pricing.

They also attract Western Canadian snowbird patients tired of waiting years to get care in Canada, and patients from 49 states where there was no robotic option nearby.

I know this because it’s the practice where I am the administrator.

The Future is Cash-Pay

No matter who wins the election, cash pay surgery is an option worth exploring. People won't ever stop needing surgery. You will thrive as long as your marketing, paid advertising, and PR strategy is effective.

Becoming a recognizable brand costs money, but you’ll easily recognize your return on investment. Return on Advertising Spend (ROAS) is easy to calculate: make at least one dollar over cost on each campaign.

The transition to a cash-pay model isn’t just about streamlining operations—it’s about reclaiming control over your practice and the ASCs financial health and future. By eliminating the influence and involvement of TPAs, ASOs, and insurance companies, you’ll not only reduce administrative headaches but also align your pricing with true cost transparency and profitability. As patients increasingly demand clarity and affordability in their healthcare options, you’re positioned to meet that demand head-on while ensuring sustainable, consistent cash flow.

Whether you’re a solo surgeon or running a bustling ASC, adopting a cash-pay strategy can accelerate your revenue cycle, enhance patient satisfaction, and future-proof your practice against the ever-changing healthcare landscape. It’s more than just a trend—it’s a pathway to growth and independence. And if you are a surgeon, in private practice, you can sell bundled surgeries yourself, just contract for the facility and anesthesia and maybe - the pharmacy.

The future of healthcare is moving towards simplicity, transparency, and direct payment models. Are you ready to lead the way? Need help? Call me. 800-727-4160. There's plenty of market share to go around.