Millions of people in the United States lack sufficient access to health care services because they live in “health care deserts” — communities with too few health care practitioners. Health care deserts persist in rural and urban areas across the entire country.
Left without access to basic care services, many people turn to costlier care in hospital emergency departments. Hospitals overcome this problem by opening clinics in neighborhoods underserved by private-practice clinicians. But hospital outpatient department (HOPD) payment cuts badly undermine these efforts. Hospital systems that otherwise would improve access by establishing clinics in underserved areas will not do so if outpatient centers are economically unworkable.
The Bipartisan Budget Act of 2015 mandated a new payment system for off-campus HOPDs, resulting in a 60 percent cut to clinics that opened after November 2, 2015. Due to their larger number of outpatient clinics, essential hospitals absorbed a disproportionate share of these cuts — 13 percent versus their status as 5 percent of all Outpatient Prospective Payment System hospitals.
New proposals from Congress, including the House-passed “Lower Costs More Transparency Act” (H.R. 5378), would expand site-neutral payment cuts to drug administration services in HOPDs, jeopardizing access to vital care, such as outpatient cancer treatment, in underserved communities.
We urge Congress to protect access to care in underserved communities and support the safety net by rejecting site-neutral policies.
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