About this same time last year, Congress enacted a reform that signaled growing support for common sense policies that ensure Medicare reimburses the same amount, for the same services despite the care setting – pro-patient policy that simultaneously lowers Medicare costs. Physicians, like myself, across the country praised Congress for taking this bold step and continue to advocate for expanding site neutral payment policies.
Today, Congress is preparing to take another very bold step by enacting the 21st Century Cures bill. While I fully support the principles and goals of the Cures bill, I urge Congress to look closely at the details and remove any provision that threatens to reverse actions previously taken to reduce costs and protect patient access to community-based care.
If passed, the Cures Act would accelerate the development of innovative treatments by cutting the red tape that holds back clinical trials while allowing for more flexibility in health data sharing so researchers can collaborate more easily. The bill also establishes an Innovation Fund to allocate more funds to the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) each year for the next five years to speed up new drug approvals and invest in new, ground-breaking cures. The Cures Act also contains several cost-savings measures that are projected to reduce the deficit by about $500 million. All noble and necessary reforms that I stand by fully.
Unfortunately, the bill also includes a very small provision that would unravel Congress’ progress on site neutral payments and restrict patient access to care while unnecessarily increasing costs to the Medicare system, elderly patients and taxpayers. Tucked within the 300 pages of legislation is a rollback of an earlier policy that establishes an equal playing field between Hospital Outpatient Departments (HOPDS) and freestanding physician’s offices. That policy, a part of the Bipartisan Budget Act of 2015 that calls on CMS to apply the same payment rates to HOPDs as it does to freestanding clinics, was a major victory for patients who will see lower out-of-pocket costs as a result.
If the goal is to move our healthcare system into the 21st Century with this legislation, the Cancer Moonshot and the Precision Medicine Initiative, why include a provision that preserves outdated reimbursement policies that increase costs for the American public?
Community cancer clinics are struggling to survive. Now is not the time to be walking back from site neutral policies. Since 2008, at least 380 cancer treatment facilities have closed while another 609 have been acquired by hospitals. Furthermore, there is no evidence to suggest that treatments performed at HOPDs are higher quality, despite being able to bill Medicare 76 percent more, on average, than freestanding clinics.
We should be expanding the site neutral payment provision, not rolling it back. Currently, only new HOPDs are subject to the site neutral law, allowing hundreds of existing practices to continue to profit from an unfair system. The shift of physicians from private practices to hospital-owned practices will only accelerate unless incentives for hospitals to acquire physician practices are eliminated. According to a Physicians Advocacy Institute (PAI) report, the number of physician practices employed by hospitals grew by 31,000 from 2012 to 2015, which is an 86 percent increase over three years. By 2015, one in four practices were hospital owned. Data show shifting care from the physician office setting to the HOPD does nothing to improve quality while increasing Medicare costs by billions of dollars.
Expanding site neutral payments reduces Medicare spending, ensures patients receive the right care in the right setting, increases patient access to care and lowers taxpayer costs. Estimates suggest that equalizing payments for all off-campus outpatient services could save $15 billion in Medicare costs annually.
Don’t muddy the noble efforts of the Cures bill by including a provision that will undoubtedly increase costs and limit choice for America’s seniors. Including a provision that rolls back site neutral payment reforms enacted just last year should be flatly rejected.
Dr. Debra Patt is the Medical Director for The US Oncology Network.