Proposal encourages office surgery

In Illinois, podiatrists and orthopedists may have a definite financial incentive to offer office-based procedures once a proposal by Chicago-based Blue Cross and Blue Shield of Illinois is enacted.

"We have identified 55 foot and ankle procedures that are already being performed in the office at least 50% of the time, and we have proposed a reimbursement level that recognizes the physician’s assumption of additional overhead costs," says Allan Korn, MD, vice president and chief medical officer. Physicians choosing to perform any of the 55 procedures in their office rather than a surgery center will receive a $200 bonus, explains Korn.

"Patient safety is our primary concern, so we have asked the Illinois Podiatric Medical Association and the orthopedic surgeons who perform these procedures to review the proposal," says Korn. He points out that his organization’s list of procedures identified within the proposal follows Medicare’s site of service guidelines.

"To my knowledge, all of these procedures require local anesthetic only, but that is one of the aspects we want local physicians to take a look at during this review process," adds Korn.

The Illinois Freestanding Surgery Center Association in St. Charles, the Illinois Podiatric Medical Association in Chicago, and several groups of orthopedic surgeons have opposed the proposal for a variety of reasons, says Mark Mayo, executive director of the surgery center association.

Not only is there a $200 bonus paid to physicians who perform the procedures in their offices, but there is also a $200 penalty for physicians who choose to perform the procedures in an ambulatory surgery center (ASC) or hospital. "This creates a $400 incentive swing for the surgeon to move the case to the office setting," explains Mayo.

Several of the procedures on the Blue Cross list that includes bunionectomies, osteotomies, phalangectomies, tenotomies, and capsulotomies may require more than local anesthetics, says Mayo.

"We are concerned about moving cases from regulated settings such as hospitals and ASCs into unregulated settings such as physicians’ offices," says Mayo. The lack of regulation for these settings means a lack of inspection, accreditation, and oversight that ensures patient safety, he adds.