Responding to a rebuke from the state's Department of Managed Health Care (DMHC), Blue Cross of California has agreed to discontinue its policy of paying physicians a higher fee for performing certain endoscopy procedures in ambulatory surgical centers. The California Hospital Association had filed a suit challenging the policy. After reviewing the policy, the DMHC concluded that Blue Cross should have sought prior regulatory approval first, as the financial incentive policy constituted a significant change in operations.
DMHC didn't ban Blue Cross outright from proceeding with its program, but it did raise legal questions which now cast a shadow over the initiative. Among other things, the DMHC said that the program could create an incentive for doctors to treat patients in a manner that rewarded them the most financially--rather than the one most appropriate for the patient's condition. It suggested that the program could violate health code rules which forbid health plans from creating policies that tend to deny, limit or delay services.
For more background on the endoscopy flap:
- read this article from the Hospital Association of Southern California