The Trump administration is proposing an expansion of a policy that will require Medicare to pay the same rate for the same service, regardless of whether it’s delivered in an outpatient hospital or independent physician office.
The proposal takes a direct shot at the hospital industry, which has long opposed so-called site neutral plans.
Hospitals currently get reimbursed more for off-campus outpatient care than physician offices or ambulatory surgical centers, a source of significant frustration for some lawmakers and fiscal hawks who argue equalizing the payment rates would save taxpayers billions of dollars.
Bipartisan site-neutral plans were debated in Congress last year with the hope of being included in a year-end spending deal, but a deal did not materialize.
In a proposed rule issued Tuesday, the Centers for Medicare and Medicaid Services (CMS) took a significant step in that direction. The agency proposed reducing payments for outpatient drugs delivered in hospitals and off-campus facilities.
CMS said the move will help ensure beneficiariesaren’t penalized with additional copays “simply based on where they receive care.”
The agency estimated the site-neutral provision would reduce outpatient spending by $280 million; Medicare would save $210 million, and Medicare beneficiaries would save $70 million in the form of reduced coinsurance.
The American Hospital Association pushed back on the proposal.
“Studies show hospital outpatient departments are more likely to serve Medicare patients who are sicker, more clinically complex, and more likely to be disabled or living in poorer, rural communities than patients treated in independent physician offices,” the group said in a statement.
Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel, Joseph Choi and Alejandra O’Connell-Domenech — every week we follow the latest moves on how Washington impacts your health.
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