Category Archives: Outpatient Surgery

US hospitals losing $1.4B in revenue per day

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Elective Procedures, Elective Surgery, Financial Reporting, Financially Distressed, Health System, Hospital, Hospital Industry, Net Income, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Outpatient Care, Outpatient Surgery • Leave a comment

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Facing a financial squeeze, hospitals nationwide are cutting jobs

Hospitals across the U.S. are losing more than $1 billion in daily revenue as they experience significant declines in patient volume during the COVID-19 pandemic, according to a report from Crowe, a public accounting, consulting and technology company. 

With the exception of those in San Francisco and New York City, health systems across the country saw patient volume decline an average of 56 percent between March 1 and April 15. As a result, net revenue at hospitals with more than 100 beds dropped roughly $1.44 billion per day, according to the report.

The report, released May 1, said inpatient admissions are down more than 30 percent, emergency room visits dropped 40 percent and outpatient surgery volume plummeted 71 percent, compared to January.

“Hospitals and governments prepared for a surge in patient volume to treat those infected with the novel coronavirus,” Brian Sanderson, managing principal of healthcare services at Crowe, said. “However, any possible surges that might have been expected due to COVID-19 patient volume appear to be dramatically offset by a significant decline in volume in all other areas.”

 

 

UnitedHealthcare’s policy will limit outpatient surgery payments to hospitals

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UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations, according to Modern Healthcare.

The outpatient surgery policy will limit the circumstances under which UnitedHealthcare will pay for certain surgeries in a hospital outpatient setting.

Taking effect in November for fully insured groups in most states, UnitedHealthcare will only pay for a surgical procedure performed in an outpatient hospital setting if the insurer determines the site of service for the procedure is medically necessary, UnitedHealthcare told Becker’s Hospital Review.

“Medical necessity reviews for site of service occur during our prior authorization process and are only conducted if the surgical procedure will be performed in an outpatient hospital setting,” UnitedHealthcare said. “We utilize our Outpatient Surgical Procedures – Site of Service Utilization Review Guideline to help make our site of service medical necessity determinations. Site of service medical necessity reviews are currently being conducted for certain surgical procedures and will apply to additional surgical procedures beginning on Nov. 1, 2019 for most states.”

In California, Colorado, Connecticut, New Jersey and New York, medical necessity reviews will begin for certain surgeries occurring on or after Dec. 1, according to a UnitedHealthcare bulletin. Site of service medical necessity reviews do not apply to providers in Alaska, Kentucky, Massachusetts, Maryland and Texas.  

With the outpatient surgery policy, the insurer said it hopes to reduce healthcare spending by guiding patients toward ambulatory surgery centers, where care may be cheaper when there isn’t a substantial medical reason for the surgery to be performed in a hospital outpatient setting.