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.
How do consumers make these decisions about their surgical care? A recent article in JAMA revealed that the top reasons consumers select a surgeon are acceptance of insurance, followed by primary care physician referral and surgeon reputation.
Consumers are also getting increasingly savvy. Though Sg2 found 65 percent of patients reported they did not research the quality of their surgeon, the study found that higher patient incomes and possession of health insurance increased the patient’s likelihood of searching for a surgeon online. Interestingly, the top healthcare comparison website used by these sought-after patients wasn’t their insurer’s website, which only seven percent of respondents used. It was — you guessed it — Yelp.
Here’s how providers can make sure consumers’ perception is accurate. In the age of reviews at our fingertips, it helps any provider to also be aware of their electronic and social profile. Commenting and responding appropriately lets patients see your level of involvement and the reviewer feedback can provide additional insight that patients or their caretakers may not have provided in your follow-up survey.
Understand current and potential partnerships.
Not surprisingly, Sg2 has consistently found a more rapid shift of procedures from an inpatient to an ambulatory setting for markets in which surgeons have ownership in ASCs.
If surgeons have part ownership, they benefit financially from the distribution check they receive from a profitable center in addition to their professional fee. They are motivated to provide not only a clinically strong experience, but also as part of the complete care relationship between the surgeon and their patient. As part owner they are vested to understand the patient experience and can also take action more readily through their overall center engagement.
Surgeons have also seen the benefits that working with a center can bring – e.g., faster care times, dedicated staff and in case of ownership, the additional distribution check. As surgeons are employed by health systems, this can make partnerships between the center and surgeon more limited or restricted. By working with the surgeons and enlisting the help of your current surgeon partners, you can help keep partnerships strong.
Understand patient demographics.
Markets serving patients with higher rates of comorbidities will experience a slower shift of surgical cases to lower-acuity settings. ASC administrators and strategists can predict the patient population primed to shift to the outpatient setting by evaluating inpatient length of stay. Patients with a length-of-stay of one day are primed to shift to the outpatient setting.
How do we do this? Since administrators are already taking on so much work, it might seem like a lot to actively identify the patient population shift. However, many centers already identify as part of their community and with the important role they play in providing access to care. In working with referring physicians and reviewing press releases of nearby health systems, they may start to broaden their offering through that information and in supporting the needs of their communities.
To learn more about evaluating market readiness in the age of consumerism, you can read the latest issue of Outpatient Outcomes. You can also get a better evaluation of your surgery center’s business solutions and inventory for maximum efficiency.