About Matt Kilton

Matt is a highly experienced healthcare executive who has spent more than 20 years leading and advising healthcare delivery organizations. His extensive knowledge of ambulatory surgery center (ASC) reimbursement, coupled with his background managing and working closely with healthcare providers, enables him to win the confidence of hospital leaders as well as the trust of ancillary providers and physicians at a time of increased consolidation and collaboration in the healthcare industry. Before joining ECG, Matt was a Principal and Chief Operating Officer at Eveia Health. In this capacity, he negotiated sustainably profitable managed care contracts for ASCs, physicians and group practices that own ASCs, and other ancillaries. In particular, Matt often assisted distressed providers in reengineering their managed care relationships and business operations. He helped a number of new ASCs prepare for opening by negotiating reimbursement agreements that positioned them for immediate as well as long-term success. Matt also worked with struggling centers to renegotiate their managed care agreements to foster a financial turnaround.

The Shift From Grouper to APC Reimbursement: Advice for ASCs and HOPDs

In 2008, when the Centers for Medicare & Medicaid Services (CMS) shifted its payment approach in the outpatient surgery industry from the nine-grouper methodology to APC-based reimbursement, many assumed that commercial payors would follow suit. But the majority of insurers continued to base reimbursement to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) on grouper-based methodologies. Their models remained enhanced or modified versions of the historical CMS ASC model, with a few differences such as mapping of CPT codes and additional groupers. The resistance to adopting an APC-based model was largely due to the high system and operational costs associated with making the switch. Continue reading