The Centers for Medicare and Medicaid Services (CMS) has put its foot down, this time on the side of patients. Many hospitals charge you more for the same outpatient tests you get in your doctor’s office. Sixty-six different services are being targeted by CMS to leverage the playing field.
Are the tests really all that different?
We are not talking about inpatient tests that happen when you are sick enough to be admitted to the hospital. We are talking about tests that are offered by different departments in a hospital. For example, you could have an echocardiogram performed at your cardiologist’s office, or you could have one done at the hospital. The acuity of your medical condition is the same. The equipment used is the same. The same doctor may even interpret the test. The only difference is geography.
If CMS paid the same dollar amount for a test wherever it was performed, it is estimated they could save $1.44 billion every year. Others estimate savings of $29.5 billion over ten years. That may sound great to you and me, but the idea of “site-neutral” payments has hospitals fighting to charge you more.
The American Hospital Association would like to tell you that they need to charge higher costs for a number of reasons. They need that added income to help pay for staffing and to prepare for disaster readiness and other operational expenses at their facilities. As resources for their communities, they provide access day in and day out for emergencies and care for vulnerable populations — the poor, the underinsured, and the underserved — that may not have access to care by doctors in an outpatient setting. After all, not all doctor’s offices accept Medicare these days. Add to that the fact that hospitals report financial losses from Medicare for a variety of reimbursement issues.
What about the patient in all of this? Hospitals no doubt are a valuable resource, but these arguments by the AHA do not address the issue of expense to the patient and why directly increasing costs for these particular tests is justified. There must be other ways to generate revenue than on the backs of their patients.
Medicare is not free and pays for only 80 percent of the large majority of outpatient tests. Charging more unfairly increases the financial burden for American seniors. Aren’t they a vulnerable population too?
The decision about site-neutral payments is not yet final, but the debate is underway. In the meantime, if you are a health care provider who offers outpatient testing in your office, consider that your first option before sending your patients to the hospital. Remember who you are supposed to be caring for: the patient.
Tanya Feke is founder, Diagnosis Life.