In the wake of a hotly contested election, lawmakers and pundits alike often speak out about the “end of bipartisanship” as we know it as we proceed towards a single-party legislative trifecta.
But for ordinary people like me, bipartisanship and passing common-sense policy is how the country keeps moving. There’s no area more ripe for bipartisan agreement than healthcare this year. Nearly 100% of Americans agree that healthcare costs are too high, and lawmakers between both parties have put forth common-sense healthcare legislation that can be passed at a moment's notice. Acquiring medical care for you and your loved ones without breaking the bank is something that all people agree on. Thankfully, Democrats and Republicans have recently come together and ushered in the next bipartisan healthcare miracle.
Congress can act right now to fix a longstanding problem in government healthcare: unfair hospital billing. A new proposal would compel government programs like Medicare and Medicaid to bill the same amount of money for the same service, whether it’s at a hospital or an independent doctor’s office. “Site-neutral” payments will save patients millions of dollars in healthcare costs, and fulfill a policy hole that both parties have sought to patch up. As doctors like me know, it’s a saving grace for my patients.
Patients have been asking for the outcomes that site-neutrality will bring for decades: transparency and cost reductions. Healthcare price transparency has completely disappeared as health insurance companies and the government have completely obscured how much prescription drugs and doctor’s appointments cost. In large metropolitan areas, prices vary between 25% up to 75% between vendors ranging from hospitals to independent practices.
Enter site-neutrality. A typical physical exam or an MRI at a hospital-affiliated doctor’s office will cost the patient thousands of dollars more than getting the exact same service at an independent doctor’s office. But patients never see where this money goes. Site-neutral payments are a helpful tool in pulling back the curtain on healthcare prices. If patients know beforehand that their services won’t cost more depending on where they are treated, they’ll be more likely to seek out that care in the first place without fear of surprise billing.
Implementing site-neutral payments will also make healthcare costs cheaper. For too long, hospitals have enjoyed free rein to mark up services knowing taxpayers and patients will foot the bill. Mandating site-neutral payments will equalize these prices for all players in the open market. The Centers for Medicare & Medicaid services estimates over $150 billion in total savings over the next ten years if site-neutrality were implemented. These aren’t just patient savings, either. Government programs will save money that can be put to use improving patient health and services, rather than enriching monopolistic hospital systems.
Site-neutrality will even have positive effects on the private healthcare market. Studies show that site-neutral payments can reduce overall Medicare spending. That reduction in spending will have positive spillover effects in the open market, helping drive costs down for everyone.
Hospital industry advocates might argue that site-neutrality would push hospitals to their limits by reducing their profit margins. But the main issue is not with hospitals themselves. The current proposed legislation, the Lower Costs, More Transparency Act, is designed to crack down on increased payments at hospital outpatient departments (HOPDs). Hospitals should be able to cover their own and their subsidiaries costs, instead of needlessly overcharging patients to make up the difference. These organizations either need to pull back the reins on consolidation, or charge patients fair amounts.
Lawmakers are ready to take this issue on and cross partisan divides to get site-neutrality signed into law. The Lower Costs, More Transparency Act has already passed the House, and it has yet to move forward in the Senate. Healthcare leaders in both parties in the Senate have discussed a new deal to get site-neutral payments on the table before the end of the Congressional session, and they should do so without delay and send it to President Biden’s desk. The future of American healthcare – and American patients – hang in the balance.
Dr. Janell Sosa is a Board Certified Family Physician at DirectMed DPC who has been practicing in New Braunfels since 2018.
