Lisa Landon, Program Administrator, Medical Reimbursement and Coding Policy
Health care is one of the most rapidly changing industries today, which is creating both an exciting and challenging period for Ohio’s businesses and citizens. One of BWC’s key goals is to ensure Ohio’s injured workers have access to quality medical care. Our Medical & Health Services Division assesses innovative technologies, new methods of treatment and advanced reimbursement approaches in the medical field.
Adopting safe and effective health care innovations may help improve injured workers’ healing experiences and promote efficiency when providing medical care. This May we kicked off a new program that demonstrates our commitment to these goals—the ambulatory surgery center (ASC) joint replacement program.
What does the program entail?
Many injured workers have work-related medical conditions that require total or partial joint replacements, also known as arthroplasties, for their hips, knees, ankles, shoulders, elbows and wrists. While they may require surgery, we also recognize that our injured-worker population often includes younger, healthier patients who may not pose the same surgical risks as older patients with multiple health issues.
ASCs are health care facilities that provide surgical services to patients that aren’t expected to require hospitalization or extended post-operative care. With their physician’s medical clearance, an otherwise healthy injured worker in need of joint replacement surgery may opt to have the procedure performed in a qualified ASC instead of a hospital under this new program.
High-risk patients or injured workers with health issues that may affect surgical outcomes will continue to be treated at hospitals. For the appropriate patient, BWC-certified ASCs offer a safe, convenient option for injured workers and the cost of treatment is often lower than hospitals.
For the program’s initial phase we are certifying ASCs to perform two joint replacement procedures which have in the past only been allowed in an inpatient or outpatient hospital setting—a partial shoulder replacement and a revision of a total shoulder replacement. In 2017, we plan to expand the program to include additional procedures which are currently only allowed in an inpatient hospital setting.
ASCs and quality
ASCs offer a safe alternative to hospitals for many surgical procedures. The State of Ohio requires ASCs to follow numerous clinical and administrative laws and rules that cover areas such as the admission, transfer and discharge of patients; personnel and staffing requirements; service standards; building requirements; quality improvement and other issues.
BWC requires all ASCs to have Ohio Department of Health license and Medicare participation to ensure they meet the standards required by the federal government. In addition, to participate in BWC’s ASC arthroplasty program, facilities must meet additional quality criteria beyond our normal ASC certification requirements including but not limited to:
- Joint replacement program in place for at least one year;
- Adequate physician credentialing criteria;
- Adequate patient selection criteria;
- Medicare and OAASC quality reporting.
With technological and safety advances, the health care industry is noting a clear trend for payers, including Medicare, to reimburse for more and more procedures in the ASC setting.
Injured worker benefits
Further facilitating injured workers’ opportunity to more effectively collaborate with their physician on the best course of their treatment, this new service expansion will:
- Increase access to high quality medical care with more site of service options for surgery;
- Allow quicker scheduling of procedures;
- Increase convenience as ASCs are often in convenient locations with free parking.
Physician and employer benefits
Similar to injured workers, physicians and employers will benefit from the option of additional procedures being performed in the ASC setting. This approach allows physicians increased options in the types of facilities that a surgical procedure can be safely performed. This flexibility can lead to increased quality and efficiency.
Likewise, employers will benefit from increased costs efficiency associated with surgeries performed in ASCs. With increased quality of care comes quicker healing and potentially, a faster return to work.
We believe this new program will ensure patient safety and increase site-of-service options for injured workers and physicians. BWC looks forward to our ASC program helping to reduce medical costs and potentially aiding injured workers to have a quicker and safer return to work. That means a win-win for Ohio’s injured workers, providers and employers.