UnitedHealthcare and other major payers are refining their policies to manage rising healthcare costs and utilization, according to Anesthesia Business Consultants President and CEO Tony Mira.
Five things to know:
1. UnitedHealthcare's recent policy update underscores the significance of utilization. The new policy proposes using preauthorization to steer certain procedures to non-hospital settings.
2. If the policy has a positive effect on patient care and payer profitability, other plans will likely follow suit, according to Mr. Mira.
3. Anesthesia practices stand to benefit because the change is "generally consistent with the prevailing anesthesia management strategy, which is to follow the revenue in the targeting of new venues and growth opportunities," Mr. Mira said.
4. However, policies encouraging the outmigration of cases could erode hospitals' payer mix, in turn hurting anesthesia practices' bottom lines.
5. Mr. Mira encourages anesthesia practices to monitor which procedures are migrating from inpatient to outpatient settings and take proactive measures.