The American Association of Orthopaedic Surgeons supports CMS' Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System's proposed rule to move the two sites of service closer to site-neutral payments.
The new rule would reduce the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments to 40 percent of the OPPS rate.
"While we recognize that payment variation by site is part of CMS' overall payment system, economic inefficiencies are created when these natural variations become inflated," said AAOS President David Halsey, MD. "The variation in Medicare payment system has resulted in inefficient care, increased consolidation of physician practices in hospital systems, and increased costs to Medicare patients who face higher co-pays for outpatient services compared to services provided in an office setting."
Dr. Halsey said in the statement that the organization supports the measure to expand site-neutral payments because it would help reduce the cost disparity between physician offices and off-campus provider-based departments, saving patients an estimated $150 million in lower copayments.
"More importantly, it will empower patients to make their own healthcare decisions such as choosing the site of service that is most convenient," said Dr. Halsey. "These benefits, in addition to an increased service cost transparency, are critical to the patient-centered care we strive to provide."
The proposed rule does not directly tackle the pay gap between hospital outpatient departments and ASCs, but it would move the inflation update factor to the same system, so both ASCs and HOPDs would see a 2.8 percent inflation update for 2019.