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Outpatient Payment Changes Threaten Access to Care in Underserved Areas

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 sources of routine care, many people turn to far costlier hospital emergency departments. Hospitals overcome this problem by opening clinics in neighborhoods underserved by private-practice physicians. But hospital outpatient department (HOPD) payment cuts significantly 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 (BBA) 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. Because of their larger number of HOPDs that reach into underserved communities, essential hospitals bore a disproportionate share of these cuts, absorbing 13 percent of the cut to non-excepted HOPDs while representing only 5 percent of Outpatient Prospective Payment System hospitals.

New proposals from Congress would expand site-neutral payment cuts to HOPDs and further jeopardize essential hospitals’ ability to serve their communities. In particular, recent policy proposals that would cut payment for drug administration services in HOPDs would challenge essential hospitals’ ability to continue vital programs, such as outpatient cancer treatment, in underserved communities.

We urge Congress to protect access to care for the most vulnerable communities and not enact further hospital site-neutral payment proposals, which would disproportionately and negatively impact essential hospitals. Essential hospitals operate HOPDs and community clinics in underserved areas and provide access to services where they are most needed. Site-neutral payments undermine these goals.

Read Our View: Outpatient Payment Changes Threaten Access to Care in Underserved Areas


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