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Insurers, hospitals clash over service shift to ASCs

A new policy that steers patients getting colonoscopies away from hospital outpatient departments and into ASCs is stirring up controversy in Minnesota, according to the Minneapolis Star-Tribune.

Under the new policy, Blue Cross Blue Shield of Minnesota would only pay for colonoscopies and endoscopies at in-network ASCs, with the insurer only paying for the procedures in hospital outpatient departments if the patient lived further than 25 miles from a surgery center. 

Three things to know:

1. Officials at nonprofit hospitals say the new policies are indicating such insurers as Blue Cross Blue Shield are not willing to pay hospitals for services at a rate that generates a margin.

2. But Blue Cross Blue Shield's chief medical officer, Mark Steffen, MD, told the Star-Tribune that increases in hospital prices for procedures aren't sustainable, and that the new policy is following a wider trend of paying for the value of care rather than using the fee-for-service models traditionally used at hospitals. Blue Cross Blue Shield said colonoscopies and endoscopies cost more at hospital outpatient departments than at ASCs.

3. Matt Anderson, interim president of the Minnesota Hospital Association, said the new Blue Cross Blue Shield policy conflicts with contract terms that allow patients to access procedures at hospital outpatient departments, even if they live close to an ASC. 

Read more here:

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