Becker's ASC Review

12 ASC MANAGEMENT New York BCBS policy change drives surgery to ASCs By Laura Dyrda E mpire BlueCross BlueShield in New York updated its coverage policy this year to drive more surgical procedures to ASCs. e policy was published Oct. 1 and went into effect Jan. 1. Empire commercial plan members now need a medical necessity re- view to have certain procedures performed in the outpatient hospital setting instead of an ASC. "Empire BlueCross BlueShield is commit- ted to being a valued healthcare partner in identifying ways to achieve better outcomes, lower costs and deliver access to a better healthcare experience for consumers," the payer wrote in the Oct. 1 announcement of its policy change. e site of care review applies to a 33- page list of procedures, including gastroen- terology, orthopedics, ophthalmology, audi- tory and nervous system procedures. ere are 111 musculoskeletal procedures on the list, in addition to common procedures such as cataract surgery and colonoscopy. Only procedures performed in the hospital outpatient setting are subject to the review; ASCs are not. e overall cost of care is typically lower for surgery centers than in hospital outpatient departments, and the move could be a boon for New York ASCs. "We feel that Empire BCBS's new site of service policy is a logical progression in the ongoing transition of surgical care toward the high-quality, lower cost setting of ambulatory surgery centers," said Jon Van Valkenburg, president of the New York State Association of Ambulatory Surgery Centers and executive director of Upstate Orthopedics Ambulatory Surgery Center in East Syracuse. "If health plans can direct patients to a clinically appropri- ate setting that saves money for patients and employers without any compromise of clinical outcomes, why wouldn't they? is decadeslong volume shi has recently accelerated, and we expect it to continue to fuel the growth of ASCs in New York and throughout the country." e policy change could have other implica- tions for the ASC landscape in New York as well. Hospitals are not supportive of the policy, which would require hospital-based physicians to direct patients elsewhere if surgery in the hospital outpatient setting isn't preapproved. "I believe EBCBS's policy will be over- whelmingly good for the freestanding ASCs in New York as the hospitals — and those surgeons who utilize the hospital's outpa- tient departments — will begin to decant their outpatient volume and drive those cases to local ASCs," said Austin Cheng, CEO of Gramercy Surgery Center in New York City. "It seems this policy will likely drive a frenzy of transactional activity or, at the very least, increased affiliations between the hospital systems and ASCs, as these large health systems will recognize the need to align their outpatient strategy with the payers' strategy." Helen Lowenwirth, CASC, administrator of East Side Endoscopy in New York City, thinks Empire is the first of many insurance carriers to enact policies driving cases to ASCs because hospital outpatient rates are so high. "Not only will this direct more patients to ASCs, which are proven to provide high-quality healthcare to patients with an excellent record of safety and positive outcomes, but will also result in lower cost to patients and the overall healthcare system, given ASC reimbursements are on average 48 percent lower than HOPD rates," she said. "ASCs are well-positioned to meet the demand of these redirected cases, and if history is any indication, will exceed patient satisfaction for care received in alternate settings." is could make New York an attractive market for new surgery center development. New York has traditionally been a tough market to break into for ASC chains and physician groups. "I hope that this would provide a greater number of opportunities for ASCs in New York than previously afforded, but it likely all depends on the response from the hospi- tal systems to this policy," said Mr. Cheng. "Either way, I believe we are about to wit- ness a clash of titans in the healthcare space in New York." n Kaiser Permanente in 2021: 5 ASC moves By Patsy Newitt O akland, Calif.-based Kaiser Permanente announced two facilities with ASCs in the first quarter and named an ophthalmologist as medical director of one of its facilities. Five Kaiser Permanente moves in 2021 so far: 1. Kaiser is building a $25 million facility with an ASC in Woodbridge, Va. The 263,000-square-foot building, dubbed the Kaiser Permanente South NoVA Hub, is expected to bring roughly 185 jobs to the area. 2. Kaiser broke ground on the addition of an 89,000-square-foot ASC and infusion services to its Murrieta (Calif.) Medical Offices, according to an April 13 LinkedIn post by the city of Murrieta. 3. Lancaster, Calif.-based Kaiser Permanente Antelope Val- ley named ophthalmologist Khodam Rostomian, MD, as medical director. Dr. Rostomian began working as medical director March 8, Antelope Valley Press reported April 18. 4, Kaiser reversed its decision to close its ASC and gastroenterology clinic in Wailuku, Hawaii, The Maui News reported Jan. 29. Kaiser announced plans to close its Wailuku Medical Office and relocate the services elsewhere in September 2020. The closure would have eliminated 28 jobs. 5. Kaiser is developing a $500 million facility in Seattle that could have an ASC, but the COVID-19 pandemic altered what may be in the final development plan, the Puget Sound Business Journal reported Jan. 10. The original plan included an ASC and urgent care services. n

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