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.

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 […]

Research
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 […]

Research
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: […]

Research
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 […]

Research
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 […]

Research
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 […]

Research
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 […]

Research
October 14, 2019

JAMA Network: Trends in Medicare Payment Rates for Noninvasive Cardiac Tests and Association With Testing Location

In settings in which reimbursement depends on test location, higher hospital-based vs practice-based payments were associated with greater proportions of outpatient noninvasive cardiac tests performed in hospital-based locations. A recent study found that site-neutral payments may offer an incentive for testing to be performed in the more efficient location. Read the Study: Trends in Medicare […]

Research
April 2, 2019

Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices

Though few patients may realize it, the cost of health care varies widely across different sites of service. A new study by the Health Care Cost Institute (HCCI) adds more evidence to the growing body of literature that shows outpatient settings cost more than office settings for performing the exact same services. In the study, […]

Research
November 1, 2018

Journal of Oncology Practice: Cost Differences Associated With Oncology Care Delivered in a Community Setting Versus a Hospital Setting: A Matched-Claims Analysis of Patients With Breast, Colorectal, and Lung Cancers

Access to high-quality cancer care remains a challenge for many patients. One such barrier is the increasing cost of treatment. With recent shifts in cancer care delivery from community-based to hospital-based clinics, we examined whether this shift could result in increased costs for patients with three common tumor types. Read the full document: Cost Differences […]

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