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.
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 […]
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 […]
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 […]
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 […]
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 […]
On June 15, the Medicare Advisory Payment Committee (MedPAC) issued its annual June Report to Congress. This report featured a chapter on aligning fee-for-service payment across ambulatory settings. According to MedPAC, “payment differences across settings encourage arrangements among providers—such as the consolidation of physician practices with hospitals—that result in care being billed at the payment […]
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 […]
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 […]
In 2014, ASCO published data on the impact of site of service and chemotherapy costs. In this updated study, ASCO takes another look at the shift towards to the hospital outpatient department (HOPD) setting and the subsequent impact on costs in commercially insured patients. Specifically, ASCO examined chemotherapy claims by a large national payor from […]
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: […]
