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 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: […]
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 […]
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 […]
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 […]
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 […]
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 […]
In a report titled, “The High Price of Hospital Care,” the Center for American Progress examines trends in hospital profits and pricing variation across geographic areas and payers. CAP offers several policy options to rein in the high cost of hospital care, including imposing site neutral payments. According to report, “hospital profitability has risen to […]
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, […]
