facility solutions

House Bill 116 goes into effect January 1, 2022. This bill has provisions that directly affect the billing practices of providers who assist in surgery. The language in the bill prohibits all practitioners providing surgical assistant services, REGARDLESS OF PROFESSIONAL DESIGNATION (MD, DO, PA-C, NP-C, CRNFA, CSA, CFA, SA-C) from billing a patient or entering into advance consent agreements with a patient in order to bill them. Further, insurance carriers are only obligated to reimburse at the average contracted rates.  Contracted rates for assistant services are a fraction of what it costs to provide the service.  The effect of this will be a significant reduction in the ability of surgical assistants to provide these services in your facilities.

Del Sol Administrative Solutions, LLC (DSAS) has been created to bridge the gap between multiple hospitals/hospital systems and the surgical-assistant community in grave need of managerial support. DSAS provides a new operating model providing one point of contact between hospitals/hospital systems-and the independent, small and large group provider Surgical Assistant market. This relationship ensures that past services provided to your surgeons and facilities remains sustainable. Of further benefit, facilities and surgeons working with chosen assistants for years, may continue such relationships with continuing familiarity, efficiency, and overall cost savings. 

The current assistant surgeon fee schedules do not support the costs associated with providing the services. While in-network rates may be sufficient to support the actual “surgical assistant” services alone, they do not provide reimbursement sufficient to meet the managerial/logistical costs to provide these services. Expenses such as transportation, cancellations, billing, scheduling, credentialing, training, on-call pay, etcetera must also be compensated. 

 We pulled historical data to extract average case times over all services and specialties from thousands of cases. We then projected  providers’ earning power in other markets given their education, skills and experience. In addition, we extracted an average case load per annum, and looked at the deficit between what contracted rates would have paid over that time period, and any remaining deficit. Assuming contracted rates pay the cost to actually “assist” in the case, the remaining deficit represents the managerial/logistical expenses elaborated above.  

No, these are management costs that remain the same regardless of provider type. 

No, only surgical cases identified by CMS’s Physician fee schedule as Assistant-at-Surgery Allowable will be eligible. 

One of the main obstacles to employing in-house surgical assistants is effectively managing the resource. Forecasting when a facility may need multiple assistants at any given time, or no assistants whatsoever is extremely difficult and unpredictable. Utilizing outside resources to manage this need can provide significant cost savings while meeting the needs of your surgeons.

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