- Medicare patients who receive care in a hospital outpatient department are more likely to be sicker than those seen in ambulatory surgical centers and also come more often from low-income areas, according to a new study commissioned by the American Hospital Association.
- According to the study, 66.6% of Medicare patients treated at HOPDs have at least one chronic condition compared to 52.8% at ASCs. HOPD patients are also 1.7 times more likely to be dual eligible and more likely to have visited an emergency department in the past three months.
- AHA is currently involved in a lawsuit filed against CMS over site-neutral payment rate changes that ultimately reduce reimbursements for off-campus hospital outpatient clinics. The policy was included in the 2019 outpatient prospective payment system rule and the lawsuit was filed in December.
The hospital industry is planning on spending the year focused heavily on its tooth-and-nail fight against site neutrality. While CMS says the policy will save Medicare an estimated $380 million in 2019 (and double that in 2020), many providers argue the rule unfairly slams a small fraction of hospitals. A study commissioned by the Integrated Health Care Coalition in September found just 200 hospitals could face a combined payment cut of $628 million this year as a result of the rule.
This new AHA-funded study was born out of a desire to "underscore the unsoundness" of equalizing payment rates among hospitals, ASCs and other locations of care, according to a release from the organization.
Unlike other providers, hospitals treat patients around the clock, AHA CEO Rick Pollack said. In addition to costs related to keeping the lights on, those patients tend to be sicker and poorer.
"Physicians tend to refer more complex patients to hospital outpatient departments for safety reasons, as hospitals are better equipped to handle complications and emergencies," Pollack said. "Proposals that treat hospital outpatient departments the same as ambulatory surgical centers and other sites of care are misguided, and ignore the health care needs of the patients and communities we serve."
Medicare patients who visit HOPDs are 1.3 times more likely to be black or Hispanic, according to the AHA-backed study. While disparities between race, ethnicity and class in relation to access to care vary from place to place, black majority census tracks are the only racial/ethnic group associated with trauma deserts in urban areas, according to a JAMA study published last month.
This week, a study from the Health Care Cost Institute found care has been gradually shifting from physician offices to outpatient settings since at least 2009. Those outpatient visits, however, cost nearly three times as much as office visits — a trend fueled by health systems gobbling up physician practices. CMS is hoping its site neutrality rule will be able to help mitigate the problem of high costs being passed on to patients.
Robert Berenson, a fellow with the Urban Institute, told Healthcare Dive the study's findings aren't a big surprise. Hospitals, the former MedPAC member said, should be "paid a little more generously" for unique services but receive equal reimbursements for services that are provided elsewhere.