During a panel Oct. 27 at the Becker's Hospital Review 24th Annual Meeting: The Business and Operations of ASCs, held in Chicago, representatives from ECG Management Consultants spoke to attendees about changes in outpatient surgical codes and reimbursement.
Todd Godfrey, associate principal of ECG Management, and I. Naya Kehayes, principal at ECG Management, discussed the codes' implications and considerations for health systems, ASCs and physicians.
Here are three thoughts from the presenters.
1. Codes changes are aimed at changing behavior. In 2017, CMS proposed removing total knee arthroplasty from the inpatient-only list. The agency also requested comment on whether partial and total hip arthroplasty should be removed from the list.
"That is the first time I've seen, in my time sitting on the asphalt of [the] government affairs committee and dealing significantly with the list and approval codes, CMS actually proposing" to move a code all the way down to ASC and bypass the hospital outpatient department, Ms. Kehayes said.
She pointed to other proposals, such as adding more hysterectomy codes, as methods to change behavior to contain costs.
"These are big, important indicators of CMS trying to optimize the opportunities for savings in the ambulatory space," she said.
2. Commercial payers are pursuing this behavior change, too. Commercial health insurers are increasingly crafting policies requiring a case be completed in an ASC setting if an ASC is available.
Today, payers seek alternative payment methods like value-based pricing alternatives, and reward high-quality, efficient surgery centers for taking on cases traditionally performed in the hospital.
"Times are changing. I was at dinner with a senior leader from a national insurance company last week, who, quote-unquote, said, 'Hospitals will have to go through detox,' because they will lose volume" to ASCs, Ms. Kehayes said. "That's what's happening with benefit designs. That's what's happening with payment policies. And you will see more and more of that going forward."
3. The value of alignment. Hospitals and physicians have a growing capacity — and opportunity — to work together to improve collections, Mr. Godfrey said.
"We're being short-sighted … or our government leaders are being short-sighted … in putting a moratorium on physician-owned hospitals," he said. "We see physician-owned hospitals as some of the highest-performing entities out there."
If hospitals and physicians develop a high-performing joint venture, high-performing organizations will follow, Mr. Godfrey said.
"We think that ambulatory surgery is a critical strategy to health systems" amid healthcare's ever-changing code and reimbursement pressures, he added.
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