As many ASCs voice support for site-neutral payment reform to target the growing disparity between ASCs and hospital outpatient departments, hospitals push back on legislator action advocating for such policies.
Sens. Bill Cassidy, MD, R-La., and Maggie Hassan, D-N.H., published a paper on Nov. 1 pushing for site-neutral payments and explaining how the policy would reduce healthcare costs for patients. The senators argued these policies could improve the financial stability of Medicare, reduce consolidation and help rural hospitals serving high-need communities.
"While many factors drive health spending, rising healthcare costs have in part resulted from an increase in consolidation among hospitals and outpatient care settings — such as physician offices and ambulatory centers," according to the paper. While two-thirds of doctors practiced independently or in non-hospital settings a decade ago, today, at least half of physicians are hospital-employed. At the same time, patients are more frequently receiving care in outpatient facilities, and inpatient admissions to the hospitals are trending downward."
Hospitals have pushed back against the two senators' framework to impose site-neutral payments on hospitals. Hospital groups, including the American Hospital Association, argue that this framework would limit critical hospital-based care, leading to increased wait times and decreased access to care for patients.
"It is irresponsible to think that clawing back up to $140 billion of Medicare spending for seniors won't destabilize access to care," AHA Executive Vice President Stacey Hughes said in a statement. "Rather than addressing the root causes driving physician acquisitions, this instead proposes dramatic and untenable Medicare cuts, reducing seniors' access to critical hospital-based care.
The AHA and the Federation of American Hospitals echoed these thoughts, while also urging Congress to address underpayments to providers and care delays and denials by commercial insurers.
"Site-neutral policies equate to Medicare cuts that threaten access to 24/7 hospital care — a framework Congress has rejected time and again," FAH Executive Vice President of Public Affairs Charlene MacDonald said. "Seniors deserve better than tired old policies pushed by the insurance industry that just threaten access to reliable hospital care."
Medicare rates for ASCs are, on average, 50% of what HOPDs receive for the same services, according to the Ambulatory Surgery Center Association.
"The market dynamic that is affecting ASCs now is the lack of site-neutral payments," James O'Leary, MD, CEO of Real Doc Speaks, told Becker's. "Hospital outpatient departments are reimbursed significantly more than ASCs for the identical service. This makes no sense, and this kind of nonsense only occurs in healthcare. There should be one fee paid to both ASCs and HOPDs and that fee would be lower than the current HOPD fee and higher than the ASC fee."