In an e-mailed news release, the ACPE noted how the poll results appeared to match the findings of a recent Medicare Payment Advisory Commission report, which noted that many hospitals and systems bill Medicare at a higher rate when outpatient services are delivered in a hospital setting. The report said Medicare could save some $900 million a year if 66 ambulatory payment areas were billed under a “site-neutral” policy.
A previous report, released in March 2012, noted that $2 billion could be saved annually by 2020 if evaluation-and-management office visit payment rates were paid the same whether they occurred in a hospital or a doctor's office. In fact, the report noted that in 2011, Medicare paid 80% more for a 15-minute office visit in a hospital outpatient department than for a comparable visit in a freestanding doctor's office.
Comments posted on the ACPE website reflected a variety of theories on why costs rise with the acquisition of practices. Some wrote that they expected this trend to reverse itself once the healthcare system moves away from volume-based payments.
“As long as the hospital system stands to make more money by feeding their specialists, the incentive to the physicians—and the subliminal message—is going to be 'do more,'” commented one ACPE member. “Once the payment mechanism is turned around to measuring outcomes and payment is not based on doing more equals earning more, then the answer you get might be different.”
Another commenter linked the increase to the cultural change within the medical profession and wrote that “as the 'doc til you drop' generation leaves medicine, the new generation of 'doc until the shift ends' will see value-based care and time away from work as more valuable than a higher salary.”
Others commented that there are some universal benefits of hospital employment and acquisition even if specific individual costs increase. “Losses in the clinic go up, but employed physicians in our experience order less tests and procedures, partly because they don't own the equipment, and partly because we have more influence over practicing evidenced-based medicine,” wrote one commenter. “The overall cost to society is less.”
One ACPE member noted how “Physicians are usually required to refer to the hospital for all ancillary services that were previously provided at far lower cost through the office.” This echoed findings of the recent MEDPAC report, released last month, which projected annual savings of $500 million if certain cardiac imaging services were billed under a site-neutral policy.
Follow Andis Robeznieks on Twitter: @MHARobeznieks
