News & Updates

November 28, 2016

CONGRESS: Protecting “Common Sense” Site Neutral Payment Policy Good for Taxpayers, Patients, Medicare Program

Alliance for Site Neutral Payment Reform strongly urges Congress to reject efforts to dial back payment parity reforms in 21st Century Cures legislation 

WASHINGTON – The Alliance for Site Neutral Payment Reform – a coalition of patient advocates, providers and payers who support payment parity across sites of service – is urging Congress to protect new payment parity Medicare policies and reject efforts to insert provisions in the 21st Century Cures package that would roll back recently enacted site neutral payments that are expected to reduce Medicare costs for patients and taxpayers.  In a letter sent to House Energy and Commerce leaders today, the Alliance expressed concerns with including provisions that would exempt cancer hospitals and certain Hospital Outpatient Departments (HOPDs) from site neutral payment policies signed into law as part of the Bipartisan Budget Act of 2015 (BBA).

While the Alliance strongly supports the goals of the Cures bill, it is asking lawmakers to protect payment policies enacted through the BBA, which equalize Medicare reimbursement for the same services delivered in HOPDs and physician practices. Provisions grandfathering HOPD facilities defined as “mid-build” prior to November 2, 2015 and exempting certain cancer hospitals from the site neutral payment law are currently included in the legislative package.

“Including a provision that rolls back site neutral payment reforms into a bill that otherwise supports significant progress in medical innovation and care is short-sighted and directly conflicts with the very principles of the legislation,” said Dr. Debra Patt, Medical Director for The US Oncology Network.  “We applaud the goals of the 21st Century Cures legislation and hope to see it enacted before the end of this session – without the provision limiting site neutral payment reforms that Congress put in place to reduce Medicare costs for patients and taxpayers.”

The Alliance warns that higher hospital outpatient reimbursements have resulted in a shift of physicians from private practices to hospital-owned practices, where higher fees for the same services can be charged. Health officials maintain that this trend will only accelerate unless the financial 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.

The Alliance believes that all off-campus outpatient facilities, not just those HOPDs built or purchased after November 2, 2015, should be subject to the site neutral payment provision. If Congress expanded site neutral reforms, data show Medicare could save more than $15 billion while simultaneously lowering out of pocket costs for America’s seniors.

“Finding new cures is a necessary and laudable step, however cures do little to improve care without access. Payment policies that pay more for care in the HOPD setting are literally leading to the elimination of independent physician practices, therefore reducing access to community based care across America.  We respectfully urge Congress to recognize the value of paying the same amount for the same service by ensuring the enacted site neutral reforms stay in place,” added Patt.

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