In the latest wave of change in healthcare, payers are actively steering patients to lower sites of care across many procedural areas. Anthem has restricted MRI and CT scans provided in hospital outpatient departments (HOPDs) in several states and plans to roll out those restrictions to 13 states this year. It has announced restrictions for emergency room care, as well.
United Healthcare is joining in, as it requires site of service medical necessity reviews for nearly 80 surgical procedures that could be furnished in an ASC to be covered in a HOPD.
Consumers are listening, particularly when it comes to elective procedures such as joint replacement. They are taking their procedures from the HOPD to an ASC setting. Sg2 saw the percentage of outpatient joint replacement surgeries performed in an ASC setting shift from 22 percent in 2013 to 44 percent in 2016.
