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Seeking $41B in savings, health plans look to ASCs: 6 insights from Optum

An extra $41 billion in healthcare costs could be saved annually if all appropriate procedures were performed in ASCs, according to Eden Prairie, Minn.-based Optum Payment Integrity Facility Ideation Leader Robin Richards.

Six key thoughts she shared:

1. Studies have shown 52 percent of procedures that could be safely done in ASCs are performed in higher-cost settings. Health plans encourage the use of ASCs — which are in the 90th percentile or higher for outcomes and patient satisfaction — to reap cost savings. Health plans will ultimately increase ASC reimbursement.

2. As health plans shift services to ASCs, acute care facility inpatient admissions will decline. An increase in ASC claim volume will drive an increase in claim auditing and monitoring.

3. Reimbursement rates between hospital outpatient departments and freestanding ASCs are leveling out. The Office of the Inspector General recommended lowering HOPD rates to equal ASC rates for some low-acuity procedures.

4. As reimbursement rates level out, health systems are acquiring fewer ASCs. However, hospitals want to maintain joint ownership to capture outpatient revenue.

5. Large orthopedic groups are establishing "mega ASCs" and moving into the cardiac space. Hospitals may create joint ventures with ASCs that don't have the staff or equipment to take on cardiac procedures alone.

6. CMS has noticed the value of performing procedures in ASCs. Its proposal to add 142 device-intensive procedures to the ASC setting will cause health plans to increase spending.

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