07/09/2014

CASA Message Having An Impact

Health Net expands ASC approved procedures

For the last seven years, the CASA Board and California corporate ASC leaders have been meeting to discuss the California trends in the ASC industry and meet with key executives and Medical Directors from the major health plans. This gathering has led to enhanced relationships between the ASC industry and the major health plans, providing education on the quality, benefits and the many services ASCs can provide.

We are pleased to report after attending this year’s summit, the Health Net Medical Director, Dr. Michael Fine, brought forward a recommendation that the Health Net Medical Advisory Committee (MAC) allow some invasive knee and hip joint replacement to be done at ASCs for commercial members. The Health Net MAC has approved his recommendation and have issued a new policy to address the issue. In summary, the policy states:

"Minimally invasive knee and hip joint replacement may be performed in an outpatient setting in specific facilities that have been contractually approved by Health Net's ancillary contracting department to perform these procedures in the outpatient setting. This approval is based on the facility's ability to select the appropriate patients, capability to provide 24 hour observation and have evidence that there is an agreement with a hospital to transfer and accept complications."

Please note that if your facility is able to do such procedures, Health Net requires that you add it to your Provider Agreement before a prior authorization can be issued for the surgery.

The full policy is already posted on http://www.healthnet.com/ for providers to view.

As reported earlier this week, the Center for Medicare and Medicaid Services (CMS) has proposed to add ten new spine procedures to the ASC approved list of procedures for 2015. CASA Board member, Tom Wilson, Orthopedic Surgeon Sohrab Gollogly, MD of Monterey CA, and staff from the Ambulatory Surgery Center Association (ASCA), conducted a presentation for CMS staff earlier this year that highlighted the safety and efficacy of these procedures when performed in the ASC setting.

It will be crucial that CMS hears from ASCs in the coming weeks supporting these additions. CASA members working together are having an impact. This recent success re-enforces our need to “Tell the ASC Story” and our message of efficiency, quality outcomes and patient satisfaction.