Site-neu­tral Medi­care pay­ments on Congress’ agenda

Modern Healthcare - - THE WEEK AHEAD - —Shan­non Much­more

Congress is likely to take up a mea­sure in the new year that would ex­empt hos­pi­tal out­pa­tient de­part­ments cur­rently un­der con­struc­tion from a “site-neu­tral” Medi­care pay­ment pro­vi­sion, which made it into the two-year bud­get deal in Oc­to­ber that avoided a po­ten­tial de­fault on the coun­try’s debt obli­ga­tions.

The pro­vi­sion sets the CMS def­i­ni­tion for provider-based, off-cam­pus hos­pi­tal out­pa­tient de­part­ments as fa­cil­i­ties not on or within 250 yards of the main cam­pus. The pro­vi­sion, meant to equal­ize pay­ments start­ing Jan. 1, 2017, grand­fa­thered ex­ist­ing out­pa­tient build­ings, but not those be­ing built. Medi­care pay­ments to out­pa­tient de­part­ments have been a con­cern for some time as prices for pro­ce­dures per­formed there have risen. A 2013 Medi­care Pay­ment Ad­vi­sory Com­mis­sion re­port found that Medi­care was pay­ing 141% more for a Level 2 echocar­dio­gram in an out­pa­tient set­ting, com­pared to one per­formed in a physi­cian’s of­fice. Pol­i­cy­mak­ers and pa­tient ad­vo­cacy groups say the dis­par­i­ties are un­jus­ti­fied, and that they in­cen­tivize hos­pi­tals to ac­quire physi­cian prac­tices and am­bu­la­tory surgery cen­ters to re­ceive higher pay­ments.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion op­poses pay­ment par­ity. It ar­gues that hos­pi­tals, with their emer­gency depart­ment and trauma ca­pac­i­ties, have higher cost struc­tures than physi­cian of­fices.

Rep. Gene Green (D-Texas) re­cently co-spon­sored a bill that would ex­empt hos­pi­tal out­pa­tient de­part­ments un­der con­struc­tion.

“Th­ese are com­mon-sense re­forms to small gim­micks in the law that have a big im­pact on pa­tients and health­care providers,” he said in a news release. “While the pro­vi­sions were not in­cluded in the larger House pack­age, they re­main a top pri­or­ity, and Congress should pass them into law with­out de­lay.”


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