May 3, 2024

New Third Way Memo: Lowering Hospital Prices while Protecting Rural Patients

A new memo from Third Way pushes back against hospital claims that legislation requiring site neutral payments for drug administration services would harm rural hospitals. Third Way finds that 99% of rural outpatient spending is unaffected by The Lower Costs, More Transparency Act. Here’s why: The site-neutral provisions would only apply to clinics owned by […]

April 18, 2024

PAI-Avalere Report on Physician Employment Trends and Acquisitions of Medical Practices: 2019-2023

PAI and Avalere Health have engaged in a long-term research collaboration to study how consolidation trends are impacting physicians. This latest report adds two additional years’ data (2022 and 2023) to previous research and provides insights into: (1) the trend of acquisitions of physician practices by hospitals/health systems and other types of corporate entities (e.g., […]

February 9, 2024

Analysis Examines Impact of Site Neutral Proposals in Rural Areas

A recent analysis from the Actual Research Corporation examines various options for expanding site neutral payments at off-campus hospital outpatient departments (HOPDs).  Findings include: “• Only 19% of Medicare off-campus HOPD spending is subject to existing outpatient payment system site neutrality policies. • Medicare and beneficiaries typically pay 2-4X more for a service in an […]

January 11, 2024

Avalere: Site Neutral Payments Affect Small Share of Spending

According to a new analysis from Avalere: The Centers for Medicare & Medicaid Services (CMS) has paid for Medicare fee-for-service (FFS) services at certain off-campus provider-based departments (PBDs) at a reduced rate since calendar year (CY) 2018. The policy was intended to reduce differences in payments between hospital-affiliated locations and independent physician offices. A review […]

December 6, 2023

New Research Dives into Site Neutral Cost Savings in the Lower Cost, More Transparency Act

A new research brief from the Actuarial Research Corporation and supported by Arnold Ventures provides a deep dive into the potential cost impacts of site neutral payments for off-campus drug administration services in Medicare. Per Arnold Ventures, the analysis estimates “if site neutral payments for drug administration in off-campus facilities had been in place in […]

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 […]

November 5, 2023

Review of Expert and Academic Literature on Site Neutral Payment Policies

The Yale Tobin Center for Economic Policy released a review of expert and academic literature assessing the status and impact of site neutral payment policies in the Medicare program. The review provides a thorough examination of site neutral payment policies already in effect and those currently under consideration in Congress. The review also notes, “In […]

October 24, 2023

ACS-CAN Study Shows Benefits of Site Neutral Payments in Cancer Care

A recent study from the American Cancer Society Cancer Action Network and Avalere reviewed Medicare costs for services a hypothetical breast cancer patient receives in a calendar year. The study found: Services provided in HOPDs were reimbursed at a rate that was 3 times higher than services provided in a physician office setting; Certain services […]

September 14, 2023

BCBSA: Costs for Common Health Care Procedures Significantly Higher When Performed in Hospital Outpatient Departments

An analysis released by the Blue Cross Blue Shield Association (BCBSA) shows the costs for prevalent procedures like mammograms or colonoscopies were consistently higher — as much as 58% more expensive — when performed in HOPD settings. Higher hospital prices mean higher costs to consumers.  The analysis looked at claims data for six common, everyday […]