Hospital groups urge Congress to stop outpatient E/M payment cap

Five hospital groups are calling on Congress to oppose a Medicare Payment Advisory Commission-proposed cap on nonemergency evaluation and management (E/M) services.

The proposal, which calls for a 71 percent reduction to hospital payments for 10 of the most common outpatient services at the rate that physicians receive for services at their offices, could be devastating for hospitals, according to the American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Federation of American Hospitals and National Association of Public Hospitals and Health Systems (NAPH).

"To pay a hospital--with our emergency department, surgical, nursing, emergency, transportation and myriad other costs--the same as a physician office does not make sense," the provider groups wrote in a letter to Congress Tuesday.

If enacted, the proposed policy could change the way hospitals are reimbursed for visits that occur in the hospital outpatient department. The physician would receive the standard amount for a service in the hospital setting, and the hospital would get the difference between the physician payment in the office, minus the physician payment in the hospital.

"Simply put, it is significantly damaging to beneficiaries and the providers on which they rely to enact legislation that will result in such large cuts," the hospital associations said.

Noting that hospitals already are underpaid for such services, the policy would lead to an additional 3 percent reduction to outpatient payments and would reduce Medicare outpatient payments to 87 percent of cost, the groups said. The reduced payments could undermine patient access to outpatient care and hospitals' ability to provide emergency stand-by capacity, they said. In addition, Pioneer Accountable Care Organizations would see an average 5.2 percent drop in Medicare outpatient prospective payments.

"This short-sighted proposal would disproportionately harm the very type of accountable care models that we are striving to foster," the hospital groups said.

Ambulatory care networks could be the hardest hit, Beth Feldpush, NAPH vice president of policy and advocacy, told HealthLeaders Media.

"Most of our members will have a cardiovascular clinic, a diabetic clinic, a pain clinic, cancer clinics, and the patients that we serve really don't have any other source of care to manage those really complex medical conditions," Feldpush said.

MedPAC estimates the adjustment would save the federal government $1 billion.

For more information:
- read the letter (.pdf)
- read the HealthLeaders Media article

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