House Energy and Commerce Committee Chairman, Representative Fred Upton, and Subcommittee on Health Chairman, Representative Joseph Pitts, have begun to solicit input from members of the healthcare community on certain policy changes, including changes made to certain Medicare hospital reimbursements on a prospective basis. Representatives Upton and Pitts are requesting feedback on policies that have the potential to amend or expand the site-neutral provision included in the Bipartisan Budget Act of 2015.
Representatives Upton and Pitts write,
Given the wide breadth of suggestions, ideas, concerns and proposals shared with the Committee on this issue, we are inviting all interested members of the health care community to provide formal feedback on policies the Committee should examine in the context of both the enactment of this provision of law, as well as other changes to site-neutral payment policies.
Not only did Representative Upton and Pitts ask for feedback and ideas, but they also asked for ideas on how to pay for any suggestions that would lead to an increase in cost for beneficiaries, by stating,
If changes are suggested that would represent an increase in cost to beneficiaries or the Medicare program, in the interest of serving patients, beneficiaries, and taxpayers, we would hope you would also suggest additional policies or payment reforms which would ensure changes are at least budget-neutral, or which would ideally further the solvency of the Medicare program.
To supplement their request for input, Representative Upton and Pitts drafted a letter explaining to the healthcare community the background behind the Bipartisan Budget Act policy, and explained how the policy came to fruition.
According to the Representatives, the policy came from many different groups expressing concern about the Medicare program Hospital Outpatient Prospective Payment System (HOPPS) paying more for services provided at hospital outpatient departments (HOPDs) than in any other setting, even more than ambulatory surgical centers, physician offices, and community outpatient settings. Several interested parties raised concerns that such payment inequity has driven hospitals to acquire standalone or independent practices and facilities, in turn, resulting in higher costs for the Medicare system and taxpayers. These actions also resulted in beneficiaries needlessly facing higher cost-sharing in some settings, compared to others.
In recent years, MedPAC has done some work examining whether payment policies that reimburse providers different amounts for identical medical services at different types of sites encourages provider behavior or market dynamics that increase costs to the Medicare program without much of a benefit to the beneficiary. MedPAC has found that implementation of site-of-service payment reforms would be beneficial, specifically, equalizing Medicare payment rates across settings for Evaluation and Management office visits and aligning rates between hospital outpatient departments and physicians’ offices for other ambulatory services or cardiac imaging services.
There have been a wealth of suggestions provided to the Committee on how best to respond to the new provisions of the law, including: make no modifications to the statute; make the current Section 603 policy retroactive; enact additional site-neutral policies across the Medicare program; adopt legislation already reviewed by the Subcommittee that would further payment neutrality in spaces such as post-acute care and oncology; and explore refinements to issues surrounding the expansion, grandfathering, or relocation of existing hospital outpatient departments in a holistic manner, while evaluating similar concerns expressed by physician-owned hospitals.
If you have comments or input you would like to provide the Committee, please ensure you submit your feedback by close of business on Friday, February 19, 2016.