Most recently, the Alliance submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) commending the interpretation of site neutral payment reforms in the Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule (CMS-1656-P). "The Alliance believes that the site neutral payment policy should apply to all off-campus outpatient departments and will continue to work with Congress to expand upon the progress made in the BBA. We applaud CMS' proposed implementation of Section 603," the Alliance letter states.
Establishing an equal playing field for Medicare reimbursements across healthcare settings reduces Medicare spending, ensures patients receive the right care in the right setting, lowers taxpayer costs, and increases patient access. Estimates from the Medicare Payments Advisory Commission (MedPAC) suggest that equalizing payments for 66 groups of specialized services between HOPDs and freestanding offices would save Medicare beneficiaries $140 - $380 million in cost-sharing over the course of a single year.
Payment equalization would also end the flawed system of incentives that encourages hospital practices to set up HOPDs that offer the same services as freestanding practices, but receive higher Medicare reimbursements. In 2013, the Government Accountability Office (GAO) found that the total Medicare payment rate for a mid-level E/M office visit for an established patient averaged $51 higher when the service was performed in an HOPD instead of in a freestanding physician's office. The disparity is even more significant among cancer treatment services. A 2012 Avalere study found costs for chemotherapy in HOPDs were 76 percent higher than freestanding cancer clinics.
The Alliance hopes that the new website will strengthen its advocacy efforts to encourage Congress to expand site neutral payment reform. Only by expanding Section 603 of the BBA, so that the provision includes practices not grandfathered in by current law, will millions of physicians, patients, and Medicare beneficiaries realize the cost savings and improved outcomes associated with site neutral payment reform. This provision, estimated to save $9.3 billion over a 10-year period, marks an important first step in equalizing payments across site of service.
The Alliance for Site Neutral Payment Reform is a coalition of patient advocates, providers and payers who support payment parity across site of service in order to decrease Medicare and commercial spending, ensure patients receive the right care in the right setting, lower taxpayer and beneficiary costs and increase patient access. To learn more, visit siteneutral.org.
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SOURCE Alliance for Site Neutral Payment Reform