Two leaders joined Becker's to discuss whether payers are pushing procedures to ASCs and other outpatient settings.
Editor's note: These responses were edited lightly for clarity and brevity.
Laren Tan, MD. Chair of Loma Linda (Calif.) University Health's Department of Medicine. 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.
Craig Sarine. CEO of University Surgical Associates (Chattanooga, Tenn.): We actually manage an hospital outpatient department for a hospital, so we somewhat fall in the middle between hospitals and ASCs. In my "day job" as the administrator of a surgical practice, we are finding payers pushing to move procedures to local ASCs and away from any hospital (inpatient, outpatient and HOPD) facilities. Fortunately and unfortunately, in Chattanooga, there is only one general ASC — all the others are specialty (orthopedic, gastroenterology, ophthalmic) oriented — so we are still able to get procedures reluctantly approved at a hospital.