- Medicare patients treated in a hospital outpatient department tend to be sicker and poorer than those cared for in an independent physician office, new research conducted by KNG Health Consulting and paid for by the American Hospital Association shows.
- The study found that Medicare patients seen in HOPDs are more likely to be under 65, have more severe chronic conditions, live in low-income areas and be dual eligible for Medicare and Medicaid.
- They are also more likely to have been previously hospitalized and treated in the emergency department than Medicare patients seen in IPOs, according to the report.
The study comes as CMS is proposing to make payments for clinic visits site neutral, meaning HOPD visits would be reimbursed the same as doctor office visits. The proposed rule — which would save Medicare $610 million annually and reduce beneficiary co-pays — also would cut down on providers' reporting requirements and raise payments by 1.25%, which the agency maintains will offset any reductions to hospitals.
Physician groups support the move, saying it would prevent hospitals passing on facility fees to HOPD patients. But hospitals have balked at the proposal, arguing that it ignores the realities that hospitals face in serving the broad needs of their communities.
"There's no good rationale for paying different rates in facilities that are owned by a hospital versus those that are independent," Fred Bentley, vice president of Avalere, told Healthcare Dive recently. "It's the exact same service. It costs exactly the same."
By showing that HOPDs treat patients who need more care, the study could bolster hospitals' claim that they should be able to bill at a higher rate for outpatient facilities than physician offices.
According to the study, 28% of HOPD visits involved a prior ED visit, versus 17% of IPO visits. The share of HOPD and IPO visits with a prior short-term acute care hospital stay was 17% and 9%, respectively. That figure increased to 19% of HOPD visits when the Medicare beneficiaries were cancer patients.
HOPD patients who spent time in hospitals also had longer and more expensive stays than their IPO counterparts — 7.37 days at $20,108 versus 5.2 days at $14,686. The stays and costs were roughly the same for patients with cancer.
"As this study clearly shows, the needs of the patient’s hospital outpatient department care for each day are different for those who choose to be seen at an independent physician office," AHA President Rick Pollack said in a statement. "Proposals that treat them the same ignore the very different clinical and regulatory demands hospitals face, and could threaten access to care."