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Site-neutral insurer contracts a reality for orthopedic group

Surgery centers have advocated for site-neutral payments with hospital outpatient departments, so the same rates are paid regardless of where the procedure is performed.

Hospital outpatient departments are typically paid more now per hospital contracts, but both CMS and commercial insurers are enacting policies to close the gap. Kim Mikes, BSN, RN, CEO of Hoag Orthopedic Institute, said during an interview for the Becker's ASC Podcast, she is starting to see site-neutral contracts from commercial insurers. HOI has both a partially physician-owned hospital and multiple ASCs.

"We are starting to obtain some site neutral contracts, meaning we get paid the same amount regardless of whether a patient's total hip or total knee is done at the hospital or surgery center, which allows us the benefit of taking patients where it is best for them," said Ms. Mikes. "There is no financial incentive for us to do patients in one setting or another."

Ms. Mikes said the site-neutral contracts allow surgeons to take patients to the best setting based on their needs. Relatively healthy patients, outside of needing a joint replacement or spine surgery, can go to the ASC, while sicker patients who need extra support have their surgery done at the hospital.

The site-neutral contract is rare because most physicians don't own hospitals and the federal moratorium on physician-owned hospitals prevents groups from constructing new hospital facilities. However, the ability of physicians and patients to make the decision on site of service is attractive and potentially a step in the right direction for patient care.

"We have the hospital, which is something that differentiates us," said Ms. Mikes. "With site-neutral agreements, we absolutely can personalize the site to the patient."

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