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Shifting Low-Risk Procedures to Ambulatory Surgery Centers

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Shifting Low-Risk Procedures to Ambulatory Surgery Centers

Shifting Low-Risk Procedures to Ambulatory Surgery Centers

Some gastroenterology, urology, ophthalmology and obstetric procedures among those being moved.

Karen Blum

Date: 04/25/2018

It used to be routine for insurance plans to cover cataract surgery or a colonoscopy performed in a hospital. But recently, some payers have started pushing back against covering some charges associated with these procedures when performed in regulated, high-cost settings.

Johns Hopkins is now embracing this movement within its own health plans, shifting Medicaid recipients participating in its Priority Partners plan and military families enrolled in its Uniformed Services Family Health Plan toward ambulatory surgery centers (ASCs) for procedures when possible.

Since Jan. 1, patients in these plans — and some commercial plans such as Maryland Physicians Care and United — who would have come to The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Howard County General Hospital for low-risk, routine procedures such as a vasectomy or glaucoma surgery, have still been receiving treatment from their regular providers, but in outpatient buildings such as Green Spring Station in Lutherville, a Johns Hopkins ASC in White Marsh, the Surgery Center of Bel Air and Knoll North in Howard County. 

“What the health plans are doing is absolutely reflective of a broader trend in the industry,” says Jennifer Parks, director of strategic program design and implementation for the Johns Hopkins Health System.           

Looking at procedures that would have sufficient patient volume to make an impact and could safely be handled in an ASC, plan administrators first identified those in gastroenterology, including colonoscopies and sigmoidoscopies; urology, including lithotripsies and vasectomies; ophthalmology, including cataract and glaucoma surgeries; and obstetric ultrasounds. More may be added in the coming years as new space, including a third medical pavilion under construction at Green Spring Station, becomes available.

“It’s a challenge, because it’s shifting locations as well as patient and provider expectations of where care is going to take place,” says Jonathan Efron, senior vice president of the Johns Hopkins Medicine Office of Johns Hopkins Physicians. “What we want to guarantee is that wherever we’re providing care within the Johns Hopkins family, patients have the highest quality and value experience.” Higher-risk patients with any concerning medical conditions will still be treated in the hospitals, he says.

A recent presentation about the shift in venues Efron shared with the JHH Patient Safety and Quality Improvement Council was well-received by some nurses who had worked in ambulatory care settings, he says: “As always, patient safety and experience are paramount concerns to us, and we are going to ensure there is no sacrifice of either of those.”

A number of tasks are still being smoothed out, including how to incorporate teaching in these expanded settings and covering transportation for patients who live in the seven zip codes surrounding the Baltimore hospitals who might not be able to get to White Marsh or Lutherville easily on their own. “No one wants to ride a shuttle for a colonoscopy, or after anesthesia, when you might be feeling queasy,” Parks says. Plans to employ an on-demand transportation company are in the works.

The program is likely to expand to members of Johns Hopkins’ Employer Health Programs and its Medicare Advantage component by 2019, she says. The development of an ambulatory network to support Sibley Memorial Hospital and Suburban Hospital in the National Capital Region also is underway.