Independence Blue Cross and Highmark have implemented new policies aimed at reducing healthcare spending by steering certain outpatient procedures from hospitals to lower-cost ASCs, according to a June 14 report by The Philadelphia Inquirer.
Philadelphia-based Independence Blue Cross launched its site-of-care review program June 1, and Pittsburgh-based Highmark implemented a similar policy Jan. 1. The policies apply to select commercially insured and Medicare Advantage members considered at low risk for complications.
Under the programs, insurers may ask physicians seeking prior authorization for procedures such as colonoscopies, hernia repairs and orthopedic surgeries whether patients can be treated at an ASC instead of a hospital outpatient department.
The effort comes as employers face rising healthcare costs. A February Mercer survey found employer-sponsored health plan costs increased an average of 6.7% this year. Insurers argue ASCs can provide many procedures at substantially lower costs than hospital outpatient settings, according to the report.
Some health systems have raised concerns about potential disruptions to care. Philadelphia-based Temple University Health System said the policy could require certain procedures to be referred outside its network because it does not own ASCs. Radnor, Pa.-based Main Line Health also said the policies could complicate care coordination when physicians lack privileges at available surgery centers.
Highmark said some health systems have responded by accepting lower reimbursement rates for procedures performed in hospitals. The insurer said it is still too early to determine the full financial impact of the policy.
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