ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.
"With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we re-examine our payer contracts with all other payers in our market,"Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker's. "Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC. I am also looking for steerage from the payers for ASC strategies in our market. As the low cost/high value provider in the market, we should see significant streerage to our facility but have not experienced that yet. With our clinical outcomes both surgically and non-operatively, we are the best value around."
Many health systems and hospitals are opting to drop Medicare plans – here are the five most recent, as reported by Becker's.
1. Duluth, Minn.-based Essentia Health will no longer accept UnitedHealthcare and Humana Medicare Advantage in 2025.
2. Quincy, Ill.-based Blessing Health will adopt a new MA model in 2025 and will only contract with BCBS, UnitedHealthcare, Molina and Total Retiree Advantage Illinois.
3. Lawrence, Kan.-based LMH Health will no longer accept Aetna or Humana Medicare Advantage beginning Jan. 1.
4. Brewer, Maine-based Northern Light Health is ending its Medicare Advantage contract with Humana beginning Sept. 30.
5. Sioux Falls, S.D.-based Sanford Health is dropping Humana Medicare Advantage in Minnesota in 2025.