In the News: Mar 8–15

Minimally Invasive Surgery May Be of Higher Value to Patients, Providers and Payers

A recent Surgical Endoscopy study analyzed the postoperative and economic outcomes of minimally invasive surgery vs open surgery for 7 common procedures in the Medicare population.

From a sample of more than 200,000 Medicare patients, the study found for most procedures, minimally invasive surgery was associated with a shorter length of stay, lower readmission rates, a lower incidence of complication and lower Medicare claim costs and reimbursements, suggesting that public and commercial payers may have an opportunity to reward appropriate use of minimally invasive surgeries by hospitals to improve clinical outcomes at a lower cost.

Sg2 believes as minimally invasive surgeries continue to shift to the outpatient setting, health systems must expand their focus beyond the hospital for their surgical services to remain relevant and competitive. For more on minimally invasive surgery and other key surgical trends, read the Sg2 report, Surgery Forecast 2017.

UnitedHealth Group Targets Costly ED Claims Under New Payment Policy

On March 1, UnitedHealth Group implemented a new nationwide policy aimed at reducing claims for costly and complex ED services for its commercial and Medicare Advantage plan members.

The insurer will review ED visit (coded as Level 4 or Level 5) hospital claims to ensure the code matches the level of services and patient care provided; if it does not, the claims could be adjusted downward or denied, depending on the contract. According to a UnitedHealth spokesman, the policy goal is to promote accurate service coding and reduce costs. However, some providers are concerned the policy will lead to further administrative burdens for health systems in aligning billing guidelines with UnitedHealth.

As insurers continue to use measures to steer patients toward lower-cost care settings, it will be critical for health systems to stay abreast of payment updates and their implications to strategic decision making. To learn more about the accelerating shift to lower-cost sites of care and its potential impact for your organization, read the Sg2 Expert Insight, CMS Continues Push Towards Lower-Cost Sites of Care.

Health Systems Pilot Hospital-at-Home Programs Despite Lack of Payment

A recent NPR Shots article highlights organizations continuing to pilot hospital-at-home programs, where certain ED patients are selected to receive inpatient care at home. Patients are usually monitored remotely and are able to interact with doctors and nurses via video chat. The article cites evidence that these programs have comparable patient satisfaction to inpatient care and provide lower-cost treatment than hospital care.

One obstacle to wider adoption of these programs has been health insurers’ reticence to pay for hospital-at-home services. Health systems have developed or expanded these programs using grants while continuing to work to prove their value to insurers.

Initiatives such as hospital-at-home programs represent health systems’ attempt to differentiate themselves in today’s evolving health care landscape. Sg2 believes that as value-based care becomes the new norm, health systems will need to recognize the increasing importance of home health and other post-acute care services. To learn more about hospital-at-home programs, read the Sg2 report, Continuing Care—Remapping the Post-Acute Path.

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