Inpatient Procedures Authorized for ASCs, Contracting Roadblocks Eliminated at CASA Annual Summit
The California Ambulatory Surgery Association recently held its fourth annual ASC Health Plan Summit, a meeting of ASC leaders and all major California health plans. The event was designed to identify common goals, work through managed care roadblocks and accentuate the positive quality and cost benefits ASCs bring to health care.
California Insurance Commissioner Dave Jones participated and presented regulatory issues affecting ASCs and the state's insurance industry. Medicare Region IX Director Herb Schultz updated the group on the latest developments in health reform, insurance exchanges and Medicaid managed care. The President of the California Hospital Association, Steve Packer, MD, offered his experience on building bridges between hospitals and ASCs.
Several clinical topics were presented to demonstrate to the health plans how procedures recently considered "inpatient only" are now commonly performed in outpatient surgery centers. These topics included higher level spine, pain management and ENT cases. Additionally, an anesthesiologist discussed how modern pain management techniques have reduced the need to keep a patient overnight for pain control.
Our meeting included considerable opportunities for the participants to network and ample opportunity for our ASC leaders to reinforce the benefits of ASCs.
CASA's annual summit has produced a significant number of positive results for the ASC industry in California to include:
• Several health plans that previously limited the number of ASC contracts they offered in a geographical area have since opened those areas.
• Countless procedures have been removed from "inpatient only" lists and now can be performed at ASCs.
• Many contracting roadblocks to moving cases from inpatient hospitals to outpatient settings, such as implant reimbursement and carve-outs, have been reduced or eliminated.
Any state that can replicate this event should do so. With sponsorships (including the health plans) and attendees paying their own way, the cost is minimal to the association. The benefits have been priceless.
Related Articles on Surgery Center Coding, Billing and Collections:
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