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Statement on OPPS, Physician Fee Schedule Proposed Rules


Statement attributable to:
Bruce Siegel, MD, MPH
President and CEO
America’s Essential Hospitals

WASHINGTON—Today’s Medicare payment rules propose deeply damaging policies that would harm vulnerable patients and their hospitals by cutting 340B savings and needed support for outpatient services in underserved areas.

Essential hospitals, which operate with a margin less than half that of other hospitals, use vital savings from the 340B Drug Pricing Program to coordinate care and improve the health of low-income and other disadvantaged patients. Given these hospitals’ fragile financial position, today’s Outpatient Prospective Payment System (OPPS) policy change—which would dramatically cut payments for most Part B drugs by 27 percent—threatens their ability to maintain critical services to patients and communities.

The Centers for Medicare & Medicaid Services (CMS) states a desire to mitigate rising drug prices, but this policy would badly undermine that goal. The 340B program provides a buffer for patients and taxpayers against skyrocketing drug prices. The proposed OPPS policy would cripple 340B’s value as a tool for lowering drug prices and disrupt access to care for those in greatest need, including low-income Medicare beneficiaries. The proposal also runs counter to Congress’ intent for the 340B program: to help hospitals stretch scarce resources.

We also are deeply troubled by the Physician Fee Schedule proposed payment rate cuts for new, off-campus provider-based departments (PBDs). CMS’ proposal to pay new, off-campus PBDs only 25 percent of the OPPS rate will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities—health care deserts—and the hospitals on which they rely. Hospitals that otherwise would seek to enhance access by establishing clinics in health care deserts will not do so if they determine this damaging payment policy makes new outpatient centers economically unsustainable.

America’s Essential Hospitals calls on CMS to withdraw these proposals and seek only changes that protect support for vulnerable patients and their essential hospitals.

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About America’s Essential Hospitals
America’s Essential Hospitals is the leading association and champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. Since 1981, America’s Essential Hospitals has initiated, advanced, and preserved programs and policies that help these hospitals ensure access to care. We support members with advocacy, policy development, research, and education.

Our more than 300 members are vital to their communities, providing primary care through trauma care, disaster response, health professional training, research, public health programs, and other services. They innovate and adapt to lead the broader health care community toward more effective and efficient care.

Carl Graziano


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