Payer policies nudging patients outside of hospital settings

Payers are increasingly issuing policies that push patients outside of hospital settings, according to Laren Tan, MD, chair of Loma Linda (Calif.) University Health's department of medicine. 

Dr. Tan joined Becker's to discuss payer behavior and what he wishes his coworkers knew about his job. 

Editor's note: This response was edited lightly for brevity and clarity. 

Question: Are you seeing payers moving procedures to the ASC setting, or are you seeing more obstacles to securing reimbursements?

Dr. Laren Tan: There are definitely more policies and obstacles being issued by payers that nudge patient care in obtaining treatments outside the hospital settings. At times the preauthorization can be complex, which leads to not only clinician frustration but also a complicated patient experience. 

It is understandable why payers are moving procedures to the ASC setting. Still, it also highlights the complexity of our healthcare environment and the increasing challenge it is and will be for clinicians as we continue to navigate the ever-changing healthcare economic landscape.

Q: What do you wish your coworkers knew about your job?

LT: I wish my coworkers knew just how proud and humbled I am to be able to serve and lead one of the most creative and innovative groups of physicians around. In my job, the famous reframed aphorism of "The right people are your greatest asset" rings true. Every day I'm able to witness firsthand the profound academic growth of learners as they progress through their training. 


It is sobering to also support and serve an incredible department of medicine with over 200 physicians and 10 medicine specialties that provide health and spiritual healing for our community. Lastly, it is gratifying and life-fulfilling to see faculty not only enter to teach and heal but also stay to thrive through lifelong learning and service. 

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