The Alliance urges Congress to stand by the site neutral payment provision included in the budget deal and expand the policy to equalize payments across sites of service for all outpatient services.



There is considerable data showing that disparities in payments across sites of service increase costs to patients, insurers, and taxpayers, as well as result in marketplace consolidation that limits patient choice by reducing access to care in the community-setting.


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Payment policies supporting higher reimbursement in the hospital outpatient department (HOPD) setting have led to a significant shift in the delivery of certain services from the community to the HOPD, resulting in increased costs to patients, employers and taxpayers.

  1. 1

    Equalizing payments across healthcare settings will benefit patients by reducing out of pocket costs, preserving patient choice and ensuring access to community-based care.

  2. 2

    Across the Medicare program, reimbursement rates vary significantly based on site of service and not the healthcare service provided. The Administration, the Medicare Payment Advisory Commission (MedPAC) and bipartisan lawmakers have all recommended site neutral payment reforms to reduce Medicare spending.

  3. 3

    Private insurance claims data also show increased spending on HOPD services is playing a major role in overall spending growth on the publicly and privately insured because of increases in both prices and volume.

  4. 4
    Market Consolidation

    The Alliance warns that higher reimbursement encourages hospitals to buy up physician practices in order to increase their profits. Unfair payment policies have put independent physician practices nationwide in a position in which selling to hospitals is their only option.