By NextBestFitSite-neutral payment
Pay the same for the same service, whether in a hospital outpatient department or an independent office.
Same pay for the same service.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Pay hospital outpatient departments the same as physician offices for the same services
- Fund standby capacity separately
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Facility fees: the same service costs more in a hospital-owned building
Equal payment for the same service across hospital outpatient departments and independent offices saves patients and payers money on routine visits. It removes the incentive to acquire practices just to add facility fees and lets independent practices compete on equal terms.
- Hospital and physician consolidation raises prices
Equal payment across settings removes the incentive to buy practices merely to add facility fees.
- Reduces income or business for affected groups
Hospitals lose revenue that partly supports emergency and standby capacity.
- Adds paperwork, coordination, or complexity
Defining which services count as the same is complex.
Who's affected
- People with unaffordable deductibles or coinsurance
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- Health insurers, brokers, and their shareholders
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- Taxpayers and public budgets
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- People with ongoing or specialist care needs
- Facility fees: the same service costs more in a hospital-owned building: Equal payment for the same service across hospital outpatient departments and independent offices saves patients and payers money on routine visits. It removes the incentive to acquire practices just to add facility fees and lets independent practices compete on equal terms.
- People with employer coverage
- Hospital and physician consolidation raises prices: Consolidation raises commercial prices without clear quality gains.
- Employers
- Hospital and physician consolidation raises prices: Consolidation raises commercial prices without clear quality gains.
- Hospitals, clinics, and care organizations
- Facility fees: the same service costs more in a hospital-owned building: Hospital systems collect facility fees on top of physician fees.
- Hospitals and specialist groups with high private prices
- Hospital and physician consolidation raises prices: Dominant systems gain from higher commercial prices.
- Health care executives
- Hospital and physician consolidation raises prices: Dominant systems gain from higher commercial prices.
- Separate standby-capacity payments
Where it has been tried
- MedPAC: Recommends site-neutral payment for many services.