For those battling chronic medical conditions, their greatest concern should be managing their health, not being charged more for where they receive care. Current Medicare policy forces patients to pay more to hospitals and hospital outpatient departments (HOPDs) than smaller practices for the same services. Congress can and should codify fully site-neutral payments through the Lower Costs, More Transparency Act to lower healthcare costs for those most in need and to eliminate unnecessary healthcare expenditures.
The Center for Medicare & Medicaid Services (CMMS) pays hospitals more than smaller practices for providing the same services. This unequal Medicare payment enables hospitals to buy smaller doctor’s offices, which consolidates the healthcare market and drives up healthcare costs for everyone. Patients are then deprived the power to shop for the best and most affordable care, especially those pursuing long-term drug administration for chronic conditions.
Although recent years have seen various legislative attempts to solve the problem, these policies have only impacted 0.8% of outpatient spending. In other words, these policies have failed, and patients are still being overcharged.
For those receiving regular drug administration, the upcharge is astronomical. Compared to the cost of drug administration at a smaller clinician’s office, hospitals and HOPDs charge between 229 and 311% more. This places an undue and unequal burden on those receiving long term drug treatment for their chronic conditions.
However, a recent study from Arnold Ventures and the Actuarial Research Corporation highlights the positive impact of fully site-neutral medicare reform for all patients, most especially those requiring chronic drug administration. They found that if Congress enacted full site-neutrality across all sites of service, Medicare patients receiving level 4 drug administration would pay $40 less per service and chemotherapy patients would save $292 on cost sharing. This means that the highest-need chemotherapy patients would save over $1,000 on their treatment.
The report also illustrated the potential overall savings in Medicare costs, finding that if site-neutral Medicare reform was enforced in 2021, $161 million in total fee-for-service Medicare costs would have been saved, along with $40 billion in beneficiary cost-sharing.
The most effective legislative proposal to accomplish these goals is the Lower Costs, More Transparency Act, which would require hospitals to adhere to full site-neutrality and clearly publish their prices. This would enable patients to pay the same price for the same service, irrespective of where they were treated, and shop for the best care. The Lower Costs, More Transparency Act puts the patient back in control and gives them the freedom to receive care where they are most comfortable without being punished. Despite deep divisions, the House of Representatives already passed the transparency package in bipartisan fashion. The Senate and President Biden should follow suit to deliver lasting change and immediate relief to millions of patients and their families.
Healthcare costs have been rising for some time, and they aren’t going down anytime soon. A large factor in rising prices is unequal Medicare reimbursements. Congress should protect patients and enforce site-neutral payments and price transparency through the Lower Costs, More Transparency Act. Through this they will demonstrate their commitment to the health of the American people, most notably those who are weakest among us.
Dr. Juliette Madrigal has been a physician in the Highland Lakes Area for 19 years. She has her own medical practice where she treats people with cancer for free, gives a discount to teachers and preachers and still makes house calls. Dr. Madrigal is also the Burnet County Health Authority, and the Medical Director for Marble Falls and Horseshoe Bay Fire Departments as well as the MFHS EMT program.
