Equalizing payments across healthcare settings will benefit patients by reducing out of pocket costs, preserving patient choice and ensuring access to community-based care.
Data show between 2009 and 2012, Medicare beneficiaries paid $4.05 million more in out-of-pocket costs because of the higher patient co-payment due to the HOPD for the exact same chemotherapy services performed at community cancer practices. Patients experience $650 annualized higher out-of-pocket costs when care is delivered in the outpatient hospital cancer facility versus independent community cancer clinic.
In 2013, the Medicare Payment Advisory Commission (MedPAC) recommended equalizing Medicare payment rates across settings for E/M office visits based on data showing that payment disparities across sites of service result in higher out-of-pocket costs to patients. The data below show how beneficiary costs rise for E/M visits when moved outside the physician office setting.