Connecticut-based insurance company Cigna is in the process of removing all one-room surgery centers in New Jersey from its network, according to a Cigna contract manager.
Jeffrey Shanton, chair of the advocacy and legislative affairs committee for the New Jersey Association of Ambulatory Surgery Centers, reached out to Cigna after a surgery center physician indicated that the insurance company intended to terminate existing in-network contracts with one-room centers.
Courtney A. Bennett, contract manager for Northern New Jersey with Cigna Healthcare, responded to Mr. Shanton, "Cigna is in the process of removing all one-room surgery centers from the network."
"I do not necessarily believe this policy is across the board, a national one," says Mr. Shanton. "I believe that the uniqueness of the New Jersey insurance landscape has something to do with the CIGNA decision. While indeed this provision has been challenged in court, and Cigna has won, I cannot help but state the obvious: These one room centers are not breaking any law. They are doing everything they can do, and are obligated to do, under current law, and indeed many would jump at the opportunity to be licensed."
In early January 2012, the New Jersey Legislature approved a bill that would require licensing for one-operating room surgery centers. The bill makes all surgical facilities — including single-room surgical practices, multi-room ambulatory surgery centers and hospitals — subject to the same licensing by the state health department. The health department does not currently license single-room centers. In addition, new centers would have to become Medicare-certified, though currently operating centers would be "grandfathered in" to Medicare certification.
In late January, New Jersey Gov. Chris Christie used a pocket veto on the recently approved bill, "effectively [killing] the bill," according to Mr. Shanton. The bill is up for approval again and has passed out of the Senate committee with no vote in the Senate as of yet. "We are working with [Sen. Joseph Vitale (D-Middlesex)] to get this done," Mr. Shanton says.
While the New Jersey Department of Health currently licenses hospitals and multi-room ASCs, the department does not license surgical facilities with a single room. Under the new law, the one-OR surgical centers will be inspected by the state health department every two to three years.
Ms. Bennett added that, "Currently, Cigna is upholding the current policy of non recruitment for one-room surgery centers. Once everything with the bill is completed, I believe that Cigna would then relook at the policy. But at this time it stands as it is."
In response to an inquiry from Becker's ASC Review, a Cigna media representative said, "Cigna supports [Senator Joseph Vitale's] efforts to license one-room ambulatory surgery centers to better protect the public health. Among other pertinent findings, a survey by the New Jersey Department of Health and the New Jersey Health Care Quality Institute found that more than 40% of unlicensed surgical practices were not compliant with safety standards, versus 15% of licensed facilities. These findings demonstrate that licensure is a strong indicator of safety and quality. Beyond that, Cigna does not comment on actions — actual or speculative — as relating to specific health care providers."
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Jeffrey Shanton, chair of the advocacy and legislative affairs committee for the New Jersey Association of Ambulatory Surgery Centers, reached out to Cigna after a surgery center physician indicated that the insurance company intended to terminate existing in-network contracts with one-room centers.
Courtney A. Bennett, contract manager for Northern New Jersey with Cigna Healthcare, responded to Mr. Shanton, "Cigna is in the process of removing all one-room surgery centers from the network."
"I do not necessarily believe this policy is across the board, a national one," says Mr. Shanton. "I believe that the uniqueness of the New Jersey insurance landscape has something to do with the CIGNA decision. While indeed this provision has been challenged in court, and Cigna has won, I cannot help but state the obvious: These one room centers are not breaking any law. They are doing everything they can do, and are obligated to do, under current law, and indeed many would jump at the opportunity to be licensed."
In early January 2012, the New Jersey Legislature approved a bill that would require licensing for one-operating room surgery centers. The bill makes all surgical facilities — including single-room surgical practices, multi-room ambulatory surgery centers and hospitals — subject to the same licensing by the state health department. The health department does not currently license single-room centers. In addition, new centers would have to become Medicare-certified, though currently operating centers would be "grandfathered in" to Medicare certification.
In late January, New Jersey Gov. Chris Christie used a pocket veto on the recently approved bill, "effectively [killing] the bill," according to Mr. Shanton. The bill is up for approval again and has passed out of the Senate committee with no vote in the Senate as of yet. "We are working with [Sen. Joseph Vitale (D-Middlesex)] to get this done," Mr. Shanton says.
While the New Jersey Department of Health currently licenses hospitals and multi-room ASCs, the department does not license surgical facilities with a single room. Under the new law, the one-OR surgical centers will be inspected by the state health department every two to three years.
Ms. Bennett added that, "Currently, Cigna is upholding the current policy of non recruitment for one-room surgery centers. Once everything with the bill is completed, I believe that Cigna would then relook at the policy. But at this time it stands as it is."
In response to an inquiry from Becker's ASC Review, a Cigna media representative said, "Cigna supports [Senator Joseph Vitale's] efforts to license one-room ambulatory surgery centers to better protect the public health. Among other pertinent findings, a survey by the New Jersey Department of Health and the New Jersey Health Care Quality Institute found that more than 40% of unlicensed surgical practices were not compliant with safety standards, versus 15% of licensed facilities. These findings demonstrate that licensure is a strong indicator of safety and quality. Beyond that, Cigna does not comment on actions — actual or speculative — as relating to specific health care providers."
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