Oct 18, 2019

UnitedHealth steering patients away from hospitals to cheaper care

Caitlin Owens, author of Vitals

Insurance giant UnitedHealth is strengthening its effort to steer patients receiving outpatient surgery away from hospitals and toward cheaper physician offices or ambulatory surgery centers, Modern Healthcare reports.

The big picture: This is part of a growing effort to address the fact that hospitals charge higher prices for the same outpatient services than other facilities.

  • A rule by the Trump administration that would require Medicare reimbursement for a procedure to be the same regardless of the site of care was recently overturned in court.
  • Hospitals hate such efforts, which threaten their revenue, and are fighting them tooth and nail.

What they're saying: "There is considerable excess spending on care delivered in sub-optimal, high-cost settings that can and should be provided in higher quality, consumer responsive and more cost-effective sites," CEO Dirk McMahon said in an earnings call on Tuesday.

Context: Beginning in November, in most states, United won't pay for certain planned surgeries performed in an outpatient hospital setting unless they've been reviewed and the location deemed necessary.

Go deeper: Hospitals' increasing revenue from outpatient testing

Go deeper

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