Dive Brief:
- In what appears to be an ongoing trend with large employers, many are looking to cut costs by excluding coverage of outpatient surgeries.
- Last year, large employers attempted to cut costs by excluding coverage for inpatient hospital care via so-called "skinny plans," which regulators deemed violated the ACA's minimum value guidelines.
- According to Kaiser Health News, these insurance plans have been mostly marketed to staffing agencies, home health agencies, restaurants, etc. -- lower wage employers that previously did not have to provide health insurance. EBSO, a benefits company in Minnesota, said more than 30 employers it works with have implemented 2016 plans that do not cover outpatient surgery.
Dive Insight:
Large employers were required to provide affordable, minimum-value coverage under the ACA starting in 2015, or fined up to $3,000 per employee. These employers are not required to offer "essential health benefits" but must provide minimum value, similar to a high-deductible "bronze" marketplace plan.
Federal regulators clarified rules for large employers, stating their plans must provide "substantial coverage of inpatient hospital and physician services," in order to be considered minimum value. Many argue that should include outpatient surgeries.
Outpatient surgical centers have increased, with more than 66% of operations currently taking place there. In addition, the number of centers qualifying for Medicare reimbursement has increased 41% from 2003 to 2011, according to the Center for Healthcare Research and Transformation. There were 23 million procedures performed in outpatient surgical facilities in 2011, according to Kaiser Health News.