According to a report from The Philadelphia Inquirer, the Philadelphia region’s largest health insurer, Independence Blue Cross (IBX), launched a policy this month that is “designed to move care into lower-cost surgery centers and away from hospitals and clinics that can generate payments twice as high for the same treatment.”
The Inquirer reports that Pittsburgh-based insurer Highmark, which recently entered the Philadelphia regional market, implemented a similar policy at the beginning of this year.
The insurers made the moves under pressure from both the federal government and employers to control costs.
IBX Chief Operating Officer Richard Snyder told The Inquirer that when doctors seek insurance authorization for certain procedures, IBX reviewers will ask whether doctors can treat low-risk patients in an ASC. “This is a gentle move,” Mr. Snyder told the paper. “We’re not willing to force you to change doctors to have your colonoscopy or your service, but we want docs to get privileges in ambulatory surgery centers.”
According to The Inquirer, IBX acknowledges that “the region doesn’t have enough low-cost surgery center capacity for a large-scale move to that setting,” which “means the policy might not hit hospital finances right away. But the implication is that the policy could take a harder edge in the future. IBX’s goal is to spur the development of more surgery centers—either by the incumbent health systems or by new competitors.”
Read The Inquirer’s full report, which dives deeply into the ambulatory surgery landscape in the region of more than six million people.
