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 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 […]
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 […]
This report analyzes current laws and regulations in 11 study states: Colorado, Connecticut, Florida, Indiana, Maine, Maryland, Massachusetts, New York, Ohio, Texas, and Washington. It is supplemented by insights from more than 40 qualitative interviews conducted between November 2022 and April 2023. Its findings provide a comprehensive look at outpatient facility fee billing in the […]
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 […]
A report from Third Way examines how hospital acquisition of physician practices is increasing prices for outpatient services across the country. The report recommends policies to move towards a payment system that ties prices to the value of the care being provided, rather than who owns the location of care, including: Expanding site-neutral payments in […]
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 […]
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 […]
