News & Updates

May 23, 2019

Alliance Opposes Legislation to Roll Back Site Neutral Reforms

H.R. 2552 threatens to raise healthcare costs for patients and taxpayers, fuel consolidation, and decrease transparency

WASHINGTON—The Alliance for Site Neutral Payment Reform (Alliance) today expressed opposition to a new bill introduced in the U.S. House of Representatives aiming to roll back commonsense reforms that are saving money for patients and taxpayers and helping to address consolidation in the healthcare marketplace.

Introduced by Representatives Derek Kilmer (WA-06) and Elise Stefanik (NY-21), the Protecting Local Access to Care for Everyone (PLACE) Act (H.R. 2552) threatens to undo the site neutral payment policy recently put in place by the Centers for Medicare & Medicaid Services (CMS).

Site neutral payments generate significant healthcare savings that directly and positively impact beneficiaries, the Medicare program, employers and American taxpayers, in addition to enhancing transparency for patients. Patients spent $411 million more in out-of-pocket costs over a three-year period when certain services were delivered in a hospital-owned setting, according to an analysis by Avalere. According to CMS, site neutral payments for Evaluation and Management (E/M) services are expected to save the Medicare program an estimated $300 million and lower patient co-payments by $80 million in 2019.

“As a member of the Alliance, the American College of Physicians strongly supports equalizing payments across practice settings. At a time when leaders across the country agree out-of-control health care costs need to come down, it is unwise to re-establish loopholes that allow hospitals to charge patients higher rates for performing the same services as community clinics or independent physician offices,” said Bob Doherty, Senior Vice President of Governmental Affairs and Public Policy of the American College of Physicians.

In order to take advantage of higher prices charged in the hospital outpatient department (HOPD) setting, hospitals are increasingly acquiring community practices, with more than 13,000 physician offices being converted into HOPDs between July 2014 and January 2015 alone. While the Bipartisan Budget Act of 2015 (BBA) aligned reimbursement rates for HOPDs that acquire new physician practices, existing off-campus HOPDs are still exempt, which is why The Alliance strongly supported CMS’ expansion of site neutral payments to all outpatient clinic visits as part of the CY 2019 Outpatient Prospective Payment System (OPPS) final rule.


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