August 28, 2022

Health Care Cost Institute: Employer-based Insurance Pays HOPDs 3x more than Physician Offices and Independent Labs for Identical Tests

A report issued in July 2022 compared prices for clinical lab tests between HOPDs and physician offices and independent labs among individuals with employer-based health insurance. The study included 232 million lab tests in 2019 resulting in $7 billion in spending. The report found the following: Employer-based insurance is typically paying 3 times more for […]

June 22, 2022

HHS OIG Confirms Medicare and Beneficiaries Paid Substantially More in HOPDs than in Freestanding Physician Offices

A report issued in June 2022 summarized the findings of an audit conducted by the Department of Health and Human Services (HHS) Office of the Inspector General that compared Medicare payments to hospital outpatient departments (HOPDs) with those made to freestanding physician offices for the exact same services. The audit examined payments for Evaluation and […]

June 16, 2022

MedPAC: Payment Differences Across Settings Encourage Consolidation, Resulting in Care Shifting Toward the Most Expensive Setting

On June 15, the Medicare Advisory Payment Committee (MedPAC) issued its annual June Report to Congress. This report featured a chapter on aligning fee-for-service payment across ambulatory settings. According to MedPAC, “payment differences across settings encourage arrangements among providers—such as the consolidation of physician practices with hospitals—that result in care being billed at the payment […]

August 19, 2021

Employee Benefit Research Institute: Physician-Administered Outpatient Drugs Cost More than $14 Billion More When Delivered in HOPD

A new study from the Employee Benefit Research Institute’s Center for Research on Health Benefits Innovation finds that employers and workers would collectively save $14.1 billion annually if price differentials between hospital outpatient departments (HOPDs) and physician offices (POs) were eliminated for all physician-administered outpatient drugs (PAODs). On average, plan payments to HOPDs are triple […]

June 29, 2021

PAI-Avalere Health Report on Trends in Physician Employment and Acquisitions of Medical Practices in 2019-2020

A study released by PAI and conducted by Avalere Health shows that hospital systems and other corporate entities continued to drive consolidation in healthcare by aggressively acquiring physician practices throughout 2019 and 2020, especially during the last half of 2020 at the height of the COVID-19 pandemic.  The study’s findings include: Only 30 percent of […]

February 24, 2021

Health Services Research: Hospital‐physician integration and Medicare’s site‐based outpatient payments

A recent study examined the relationship between Medicare’s site-based outpatient billing policy and hospital-physician integration, using Medicare claims data from 2010 to 2016. The study estimated the dollar value associated with hospitals acquiring physician practices or employing physicians by using each physician’s bundle of Medicare services. Overall, the study found the financial incentive was large: […]

February 23, 2021

Health Savers Initiative: Equalizing Medicare Payments Regardless of Site-of-Care

A joint venture between the Committee for the Responsible Federal Budget, Arnold Ventures, and West Health recently released a policy brief recommending policymakers consider “Equalizing Medicare Payments Regardless of Site-of-Care” to reduce health costs for households, businesses, and the federal government. In part, the authors argue: “higher payments are difficult to justify when offered to […]

February 22, 2021

Employee Benefit Research Institute: Location, Location, Location: Cost Differences in Health Care Services by Site of Treatment — A Closer Look at Lab, Imaging, and Specialty Medications

It is estimated that 20–30 percent of overall health care spending may be wasteful. The Feb. 18 edition of EBRI’s Issue Brief focuses on waste related to pricing failures when it comes to lab; imaging; and special medications for conditions such as multiple sclerosis, rheumatoid arthritis, and other inflammatory disorders. Takeaways:  In the aggregate, employers […]

April 29, 2020

Community Oncology Alliance Practice Impact Report, April 2020

The 2020 Community Oncology Practice Impact Report documents that 1,748 community oncology clinics and/or practices have closed, been acquired by hospitals, merged, or reported financial struggles since 2008. Data also shows 20.8% increase in practices merging with, or being acquired by, another community oncology practice and/or acquired by a corporate entity since 2018. Read the […]

January 21, 2020

Employee Benefit Research Institute: Cost Differences for Oncology Medicines Based on Site of Treatment

Previous research demonstrates that payments from third-party payers for infused oncology medicines are higher when care is provided in hospital outpatient departments (HOPDs) compared with physician offices (POs). Some have speculated this is due to differences in patient characteristics and treatment regimens between the two sites of care. This study employed a novel analytical approach […]