Proposed Medicare cuts jeopardize entry to take care of sufferers and communities

Will the care be there?

A confluence of unprecedented challenges during the last three years, together with workforce shortages, skyrocketing prices of offering care and provide chain disruptions, poses a critical danger to America’s hospitals’ and well being methods’ skill to do what communities throughout the nation depend on them for — offering high quality and accessible care 24/7 to all who want it. These headwinds additionally embrace an getting older inhabitants in want of medical care and the need to spend money on newer amenities and technological upgrades, resembling these to combat towards rising cybersecurity threats and to make sure sufferers have entry to the most recent cutting-edge scientific breakthroughs.
With all that’s at stake, now is just not the time to broaden flawed insurance policies that undermine the distinctive providers hospitals present for his or her sufferers and the important roles they play of their communities.

Congress is contemplating several pieces of legislation that may impose billions of {dollars} in extra Medicare cost cuts for providers supplied by hospital outpatient departments (HOPDs). If enacted, these misguided so-called “site-neutral” insurance policies would scale back affected person entry to important well being care providers, significantly in rural and different medically underserved communities.

Listed here are 5 causes these proposals are flawed and must be rejected.
Website-neutral cost insurance policies are primarily based on an misguided assumption that hospitals are overpaid for outpatient providers supplied to Medicare sufferers. The fact is Medicare severely underpays hospitals for the price of caring for sufferers. The truth is, AHA survey data shows hospitals obtained cost of solely 84 cents for each greenback spent caring for Medicare sufferers in 2020. Even with out these newly proposed cuts, Medicare outpatient margins are already a staggering negative 17.5 percent. In the meantime, hospitals’ expenses increased by 17.5 percent between 2019 and 2022, whereas Medicare charges for outpatient care elevated by solely 7.5 % throughout this era.

Sufferers, significantly these in rural and medically underserved communities, might lose entry to native hospital care. Most rural hospital funding comes from authorities payers, and Medicare contains almost half of their income. Medicare’s power underpayments have contributed to at least 149 rural hospitals closing or converting to another type of provider since 2010. Moreover, different forms of websites of care usually don’t find in any respect in rural or city areas the place the industrial insurer affected person combine is decrease. Additional site-neutral cuts would result in devastating monetary hardship, diminished entry to important providers and applications, and extra hospital closures.

HOPDs deal with sicker, lower-income sufferers with extra advanced and power circumstances than these handled in unbiased doctor places of work or ambulatory surgical procedure facilities. That is partly as a result of hospitals are higher geared up to deal with issues and emergencies, which regularly require the usage of extra sources that different care settings don’t usually present, resembling entry to ICUs and different important hospital providers.

Website-neutral proposals don’t account for key variations between HOPDs and different websites of care. The price of care delivered in hospitals and well being methods takes into consideration the distinctive advantages solely they supply to their communities. This contains sustaining standby capability for pure and man-made disasters, public well being emergencies and different surprising traumatic occasions. As well as, hospital amenities should adjust to a way more complete scope of licensing, accreditation and different regulatory necessities in comparison with different websites of care. Hospitals additionally ship around-the-clock emergency care to everybody who walks via their doorways, no matter their skill to pay or insurance coverage protection.

Health insurers and private equity firms — not hospitals — are liable for a lot of the acquisition of physicians over the last 5 years. On the similar time, as doctor polling information has proven, most physicians are selecting to grow to be employed slightly than function their very own apply as a consequence of elevated prices and burden from insurance policies like industrial insurer prior authorizations. Clinicians persistently inform us they might slightly deal with the apply of drugs and their sufferers and never must be liable for creating their very own infrastructure, for instance, with digital medical information or paying legal responsibility premiums. In offers the place well being insurers purchase doctor practices, the typical variety of acquired physicians per deal was more than ten times higher for well being insurers than for every other acquirer sort, together with hospitals and well being methods, in line with an AHA evaluation of knowledge from Levin Associates.

When individuals see the blue and white “H” image, they consider therapeutic, hope and well being. They really feel comforted realizing assistance is right here. Hospitals and well being methods present care to all who want it, 24 hours a day, seven days every week, one year a 12 months.

Individuals should notice what’s at stake. Congress ought to reject these dangerous proposals, and as an alternative work to strengthen entry to important take care of sufferers and communities throughout the nation.

Rick Pollack is the president and CEO of the American Hospital Affiliation.