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.
On May 23, 2024, the House Committee on the Budget convened a hearing at which Chapin White, the Congressional Budget Office’s Director of Health Analysis, testified about how consolidation among hospitals and physicians affects the federal budget. In the Q&B below, CBO responds to a question for the record submitted by Chairman Arrington. Question. Can you […]
A recent study from Third Way examines hospitals’ claim that low Medicare reimbursement is driving higher commercial rates. The study examined two large hospitals, Duke Regional in North Carolina and Mercy Hospital Southeast in Missouri, considering hospitals that make money from Medicare payments, the high quality of care efficient hospitals provide, and the possibilities or […]
A June 2024 working paper from the National Bureau of Economic Research examined the effects of rising healthcare prices on labor costs. The authors note that since 2000, prices in the hospital sector increased faster than prices in any other sector of the economy without reflecting improvements in quality. “Rising health care prices increase health […]
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 […]
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., […]
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 […]
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 […]
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 […]
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 […]
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 […]
