Starting Nov 1 of this year, United Healthcare will no longer pay for numerous planned surgeries executed in hospital settings. The new policy intends to shift as many as possible outpatient surgeries to lower cost settings outside of the hospital. This change forecasts a significant dent in current hospital revenues. United Healthcare stated that the policy is meant to control spending while continuing to provide access to quality healthcare. However, Lyndean Brick, President and CEO of healthcare consulting firm, Advis, stated bluntly to Modern Healthcare: “This policy really shifts the burden to the patient and the physician to prove that a hospital site is warranted. What is distressing is that it’s adding another level of complexity to an already complicated system of pre-authorization.” The policy is consistent with a growing number of initiatives by insurers to reduce costs by encouraging patients to look outside of hospital settings for care. But be advised: the new policy may have serious implications for hospital revenues.
At Advis, we specialize in healthcare consulting services for hospitals and healthcare providers. Helping hospitals maintain revenue levels is a top priority. As specialists in ambulatory surgery centers, acute care hospitals, and micro-hospital development, we are expert at assisting providers to navigate today’s changing policy priorities and their many ramifications. For more information, please contact us for further information.