The healthcare industry is experiencing monumental changes due to policy shifts and the aftermath of COVID-19. Insurers are taking stock of the situation and see a huge opportunity to direct more care to outpatient settings.
Here are seven takeaways from conversations with payer executives for the Becker's "Payer Issues" podcast.
1. Inpatient elective surgery will become unnecessary for most patients. One executive told me he sees inpatient care outside of the ICU will "go the way of the Dodo bird."
2. Insurers will direct far more surgeries and services outside of hospitals. ASCs and home care are more attractive for payers and fit within their value-based care strategies.
3. Hospitals will need to reposition themselves to offer more outpatient services and ASCs to capture surgery revenue, and change their strategy to focus on boosting margins with their services instead of by increasing patient volume.
4. Price transparency will move more cases to the ASC. Hospitals are already required to post negotiated rates online, and payers will be required to do the same in July. Insurance companies no longer want to pay higher rates at hospitals when patients could be served at ASCs.
5. The move toward transparent prices also makes certificate of need laws obsolete, which could be a boon for ASCs if states remove those policies. Serious efforts are already underway in South Carolina to eliminate the certificate of need requirement.
6. During the pandemic, many more surgeons were forced to take joint replacements and other big surgeries to ASCs. The surgeons realized joint replacements and spine procedures could be performed safely in ASCs and appreciated the efficiency of surgery centers. Now, those surgeons want to continue taking cases to ASCs as COVID-19 surges wane.
7. There may be a strategy shift for payers to decide on rates for procedures and then leave the decision about which setting is best for the patient up to the physician.