New Report Outlines Potential Pitfalls of Site-neutral Payment Policies > Hospital Association of Pennsylvania


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New Report Outlines Potential Pitfalls of Site-neutral Payment Policies

April 11, 2019

A recent American Hospital Association (AHA) report provides new insight into site-neutral payments, which may impact the reimbursement rate for the care that hospitals provide to patients in outpatient settings. This policy approach calls for standardizing the payment rate for some services, without taking into context the types of facilities in which the services are provided. The report sheds additional light on the intersection of these payments and the demographic variation among patient populations. Its findings illustrate unintended consequences of site-neutrality that threatens access to care for vulnerable populations.

The report analyzes differences between Medicare surgical care patients within hospital outpatient departments (HOPD) and ambulatory surgical centers (ACS) and finds that Medicare-funded HOPD patients are more likely to be sicker and poorer than those at ASCs.

Patients also are more likely to be:

  • Over age 85 (or under age 65 and living with certain disabilities or life-threatening diseases)
  • African American/Black or Hispanic
  • Living in low-income neighborhoods
  • Suffering from chronic conditions
  • Dually eligible for Medicare and Medicaid
  • Previously hospitalized or cared for in an emergency department

The report echoes findings from AHA’s September 2018 study, which found similar characteristics among Medicare patients receiving care in HOPDs versus independent physician offices.

Pennsylvania does not have a public hospital system; all hospitals in Pennsylvania must have the capacity to be open 24 hours a day, seven days a week, to treat all patients, regardless of their health status or ability to pay. Hospitals have emergency stand-by capacity that provides a safety net for vulnerable patients, and provides specialized services such as trauma, psychiatric, obstetrics, and pediatric emergency care.

HAP believes that care settings are not neutral, and that patients should receive high-quality care in the most medically appropriate setting, as determined by the patient and his or her care team. HAP will continue to work with policymakers and members of the legislature to communicate the importance of maintaining access to the important care that hospitals provide.

For more information, contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, or Kate Slatt, HAP’s senior director, innovative payment and care delivery.

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