There is considerable data showing that disparities in payment across sites of service increase costs to patients, insurers and taxpayers as well as result in marketplace consolidation that limits patient choice by reducing access to care in the community-setting.

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 […]

June 26, 2023

Paragon Policy Brief on Site Neutral Payment Refrorms

A recent policy brief from Paragon Health Institute finds “enacting ‘site neutral’ policies across health care settings can save taxpayers and patients money without sacrificing quality and can fight provider consolidation.” The brief  is intended to provide an overview Medicare site of service differentials, their implications, recent policy actions to address them, and potential options […]

April 26, 2023

New Survey Finds Strong Support for Site Neutral Payment Reform

A recent survey of registered voters conducted by a bipartisan polling team and supported by Arnold Ventures found the following: 85% of voters support limiting outpatient fees to the same price charged by doctors in the community 75% of voters support preventing hospitals from engaging in business tactics that reduce competition 80% of voters say hospital […]

March 16, 2023

Brookings: Enact Site Neutral Payments to Increase Competition

A recent report from the Brookings Institution highlights several policies that could reduce health care costs by increasing competition. The authors argue these policies have attracted various levels of bipartisan interest in recent years and could make progress in a divided Congress. According to the report, “In addition to the direct costs, paying more for […]

March 10, 2023

BCBSA: Site-Neutral Payments Would Save Nearly $500 Billion Over 10 Years

The Blue Cross Blue Shield Association (BCBSA), a member of the Alliance for Site Neutral Payment Reform, recently released a white paper titled, “Delivering Lower Costs for Patients and Taxpayers Through Site-Neutral Payment Reform,” which makes several recommendations to lower costs for patients and the Medicare program by bringing payment parity for certain medical services […]

February 14, 2023

Health Savers Initiative: Site-Neutral Payments Would Lower Private Health Costs, Encourage Competition

A recent report published by the Health Savers Initiative examined site-of-service payment issues in the commercial market. Digging into the problems with site-specific payments, the report explains, “site-based payments create incentives to provide services in higher-cost settings, generally hospital outpatient departments (HOPDs) instead of independent physician offices. Importantly, these site-based incentives also encourage vertical integration […]

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 […]

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