Payers are continuing to look at ASCs as a way to cut costs, leaders said at a March 22 California Ambulatory Surgery Association summit with payers and industry stakeholders.
Here are five reasons payers are pushing procedures to the ASC setting, according to Naya Kehayes, partner and ASC practice leader at ECG Management Consultants, who spoke at the event.
- Payers are looking to ASCs due to advancements in clinical technologies, enhanced recovery protocols, hospitals redirecting cases to ASCs, Medicare and commercial payer policy changes, physician motivation and alignment, patient expectations and demands, and payer and employer cost pressures, according to Ms. Kehayes.
- Medicare has approved many high-acuity surgeries for ASCs including total knees, total hips, laminectomies, anterior cervical discectomy and fusion, hysterectomies, breast reconstructions, lap cholecystectomies and cardiology procedures, according to an email shared with Becker's.
- In the "shopping era" of healthcare, patients have more access to cost information due to price transparency and online tools available from payers that inform them of their out-of-pocket responsibility by site of service.
- Many payers are establishing site-of-service policies, including UnitedHealthcare’s 2023 site-of-service policy, which includes 1,041 codes for commercially-insured patients and 167 codes for Medicare Advantage patients that require pre-authorization for the surgery to be performed in an hospital outpatient department.
- There is an increased demand for hospitals and health systems to align with physicians in ASC joint-ventures, Ms. Kehayes said.