Payers are incentivizing physicians to perform procedures in low-cost settings, which means ASCs are becoming increasingly attractive, according to ASC leaders.
Insurers are finally seeing the cost savings potential in the outpatient setting. In the last decade, payers have caught on that ASC procedures are about half the cost of a hospital, according to a report from Regent Surgical Health.
"Many payers are developing steerage mechanisms to shift cases to lower-cost settings which will result in more pressure on physicians to move cases to the outpatient ASC arena," Andrew Lovewell, administrator of the Surgical Center at Columbia (Mo.) Orthopaedic Group, told Becker's.
In November 2019, UnitedHealthcare adopted a policy that restricted sites of care for some nonurgent surgeries. The payer now reimburses for surgeries performed in hospital outpatient departments only if the setting is medically necessary based on the acuity of the patient.
In April 2021, Empire BlueCross BlueShield in New York began requiring a medical necessity review to have certain procedures performed in the outpatient hospital setting instead of an ASC.
"With the continued rising cost of patient care in the hospital setting, ASCs have become many insurance companies' preference for outpatient surgery," Dianna Reed, administrator of Sani Eye Surgery Center in Templeton, Calif., told Becker's.
There are also financial incentives for physicians to own and practice at ASCs. Physicians stand to win big with an ASC ownership stake.
"Physician ownership preserves efficiency, is a great recruitment tool and keeps costs down for our patients," Scott Thellman, MD, surgeon at Lawrence (Kan.) Plastic Surgery, told Becker's.