DHPA joined the American Academy of Ophthalmology, the American Association of Clinical Urologists, the Infusion Providers Alliance, LUGPA (Large Urology Group Practice Association) and the Outpatient Ophthalmic Surgery Society, in signing a letter to the GOP Healthy Futures Task force with suggestions for policies that would increase competition and reduce anti-competitive consolidation.
The letter was submitted in response to the task force’s request for information in early January and focused mainly on Section IV, entitled “Increasing Competition and Identifying Anti-Competitive Consolidation.” In the letter, the groups outlined several targeted steps Congress can take to level the play field and encourage more competition within the U.S. health care system:
- Reduce the disparity in payments between HOPD and the physician office and/or ASC for identical procedures. The policy of paying hospitals substantially more (in some cases twice as much) for the identical services provided in a physician office, infusion center or ambulatory surgery center (ASC), paradoxically, acts as a disincentive to pursuing innovations that shift care out of the higher cost hospital setting, thereby perpetuating inflationary cost trends and inhibiting patient access.
- Provide physicians with a reasonable annual payment update. Under current law, physician payments for caring for Medicare beneficiaries are frozen indefinitely, and subject to sequester which will be phased back in this year. Physician practices are grappling with enormous cost challenges, including hiring and retaining nurse and back-office staff, and need a predictable annual payment update reflecting these increased costs to successfully compete with large hospital systems.
- Establish a threshold of charity care in the tax code for non-profit hospital status. Congress should establish a minimum threshold of bona fide charity care for hospitals to reap the many benefits of their non-profit status, including not paying taxes and being made eligible for hugely profitable 340B drugs which they dispense at substantial markups.
- Repeal the Inpatient Only (IPO) List. Elimination of the IPO list and expansion of the ASC Covered Procedures List (CPL) would promote beneficiary access to safe and convenient sites of care while expanding access to innovation and contributing to significant savings in Medicare spending.
- Cap out-of-pocket cost-sharing for Part B drugs administered in physician offices and ASCs. While beneficiaries receiving care at hospital outpatient departments have a cap on their cost-sharing, those who receive the identical Part B drug in a physician offices or device-intensive procedure in an ASC are subject to unlimited 20% coinsurance. The lack of a copay cap in the physician office for Part B drugs and in the ASC for surgical procedures creates perverse incentives to provide care in the more expensive hospital setting.
The groups wrote in the letter, “The Medicare program and tens of millions of Medicare beneficiaries will benefit from these changes by increasing access to more affordable health care. We stand ready to work with you and Members of both parties on these ideas.”
Click here to read the full letter. >>