A recent policy modification designed to curtail Medicare spending has not yielded the desired results in the context of outpatient surgeries. This policy, implemented nationwide, required doctors to secure prior approval from Medicare before scheduling certain outpatient procedures. The intention was to ensure that surgeries conducted in hospitals were medically crucial and not merely aesthetic in nature.
Such procedures include blepharoplasties (eyelid surgeries), abdominoplasties (commonly known as tummy tucks), botulinum toxin injections (Botox), rhinoplasties (nose reshaping procedures), and vein ablations (removal of visible veins). Enforced through policy CMS-1717-FC, Medicare patients were required to get prior authorization before these surgeries were carried out in hospital outpatient surgery departments.
This policy, however, did not apply to ambulatory surgeries, which are typically less expensive for same-day procedures compared to hospital outpatient departments. Despite this, such centers must adhere to Medicare’s regulations, which restrict coverage of procedures that are not medically necessary, with penalties for billing Medicare for purely cosmetic procedures.
A study conducted at the University of Michigan Medical School, led by Dr. Joseph N. Fahmy, sought to determine the effectiveness of this policy in reducing surgical volume in hospital outpatient departments. The findings revealed no significant reduction in surgical volume following the policy’s implementation. The shift from these centers had begun before the policy was introduced and did not accelerate afterward.
While the policy was intended to reduce surgical volume and transition surgical care from pricier hospital outpatient departments to ambulatory surgical centers, the results indicate that it was unsuccessful in expediting this process. Dr. Fahmy noted that prior authorization generally disrupts administrative workload and the timeliness of care. He stated that the policy has increased administrative workload without reducing the volume of surgeries at hospital outpatient departments.
The policy’s implementation has resulted in additional paperwork for patients, potentially delaying their care. This underscores the importance for administrative teams to be prepared for increased workload and for patients to be aware of potential delays in receiving care.
Given these outcomes, Dr. Fahmy and his team believe that policy changes are necessary to redirect the flow of surgical patients without overwhelming administrative teams. They advocate for policy changes that constrain spending, such as reducing payment disparities between different facilities performing the same surgery. The data suggests that alternative policy measures may be more effective in reducing national surgical care spending without increasing administrative workloads. This could potentially include narrowing the payment gap between hospital outpatient departments and ambulatory surgery centers for similar care.
Comments are closed for this post.