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Medicare patients who receive care in a hospital outpatient department clinic are more likely to be poor, previously hospitalized and have severe chronic conditions than those treated in an ambulatory surgical center, according to a study by KNG Health Consulting released today by the AHA. The Centers for Medicare & Medicaid Services reduced payments for off-campus HOPD clinic visits under the outpatient prospective payment system final rule for calendar year 2019, prompting the AHA and Association of American Medical Colleges, along with three individual hospitals, to file a lawsuit alleging the agency acted outside the law.

Medicare already reimburses hospitals – which have more comprehensive licensing, accreditation and regulatory requirements than do freestanding physician offices and ASCs – less than the cost of providing care. For example, Medicare margins for outpatient services were negative 12.8 percent in fiscal year 2017, while overall Medicare margins were a record-low negative 9.9 percent. Compounding these shortfalls with proposals that treat HOPDs and ASCs the same could threaten access to care for the most vulnerable patients and communities, AHA said. 

“America’s hospitals and health systems provide around-the-clock care to all who come to us; this includes the sickest patients and those in the most vulnerable communities,” said AHA President and CEO Rick Pollack. “Physicians tend to refer more complex patients to hospital outpatient departments for safety reasons, as hospitals are better equipped to handle complications and emergencies. Proposals that treat hospital outpatient departments the same as ambulatory surgical centers and other sites of care are misguided, and ignore the health care needs of the patients and communities we serve.”