News & Updates

November 10, 2023

New Whitepaper Examines Impact of Site Neutral Payment Reforms Across Multiple Disease Groupings

A new study conducted by Wakely Consulting Group and sponsored by the Leukemia & Lymphoma Society examines the impact of site neutral payment across outpatient settings, finding that these reforms have the potential to “significantly reduce out-of-pocket patient spend.” The analysis focuses on eight disease groups: breast cancer, colitis, chronic obstructive pulmonary disease (COPD), Crohn’s disease, multiple myeloma, multiple sclerosis, non-Hodgkin lymphoma, and rheumatoid arthritis.

Among the studies’ findings:

  • For services that are safely performed in all settings, hospital outpatient department (HOPD) payment rates were 1.5 to 4 times higher than the freestanding office payment rates for the same services.
  • In one example, for a commercial breast cancer patient receiving one radiation treatment per day, five times a week, for five weeks, treatment would be about $19,095 more expensive in an off-campus HOPD compared to a freestanding office across the treatment schedule.
  • In another example, for a commercial breast cancer patient receiving chemotherapy once every three weeks for six months, treatment would be about $2,500 more expensive in the off-campus outpatient hospital setting compared to the office setting.

While the analysis focused on the effect of site neutral policies rather than potential reform solutions, it notes that one potential reform would be to eliminate the Bipartisan Budget Act’s grandfathering effects which currently allow off-campus outpatient departments who billed as provider-based departments before November 2, 2015, to continue qualifying for reimbursement under the Outpatient Prospective Payment System (OPPS).

To read the study in full, click here.