Oct 15, 2019

Hospitals' increasing revenue from outpatient testing

Photo by John Moore/Getty Images

The gap between what hospitals and physician offices were paid by fee-for-service Medicare for outpatient cardiovascular tests increased between 2005 and 2015, as did the proportion of these tests that took place in hospitals, according to a new study in JAMA Internal Medicine.

Between the lines: When payment rates depended on where the tests were performed, there was a shift in volume toward the more expensive location.

  • The same didn't happen within a comparison group of 3 health maintenance organizations, for which reimbursement wasn't tied to the testing location.

By the numbers: Traditional Medicare paid hospitals 1.05 times more than doctors' offices for testing in 2005. This increased to 2.32 times more in 2015.

  • Meanwhile, the proportion of hospital-based testing increased from 21.1% in 2008 to 43.2% in 2015. In the control group, the proportion decreased from 16.6% to 15.2%.
  • This shift to the hospital setting cost an estimated $661 million in 2015.

Why it matters: Hospitals have fought fiercely against measures to create site-neutral payments, which the Trump administration proposed last year. The rule was recently overturned in court.

  • Advocates of site-neutral payments say they save taxpayers and seniors money.
  • "Site-neutral payments may offer an incentive for testing to be performed in the more efficient location," the authors of the study write.

Go deeper: Why Medicare is going after hospital outpatient rates

Go deeper

UnitedHealth steering patients away from hospitals to cheaper care

Insurance giant UnitedHealth is strengthening its effort to steer patients receiving outpatient surgery away from hospitals and toward cheaper physician offices or ambulatory surgery centers, Modern Healthcare reports.

The big picture: This is part of a growing effort to address the fact that hospitals charge higher prices for the same outpatient services than other facilities.

Go deeperArrowOct 18, 2019

Hospitals lobbying to change Medicare's pay formulas

Texas Health Resources is part of a new lobbying alliance. Photo: Texas Health Resources

Several hospital systems are lobbying Medicare to stop basing certain payments on their sticker prices, also known as "chargemasters" — prices the Trump administration has required them to disclose publicly.

The intrigue: Hospitals aren't advocating for lower Medicare payments. They want to reduce the prices they list publicly, while retaining the same Medicare revenues.

Go deeperArrowOct 24, 2019

Hospitals dodge price transparency bullet with delayed Trump decision

Illustration: Aïda Amer/Axios

The Trump administration is promising to issue a "forthcoming final rule" related to its proposal requiring hospitals to post all of their privately negotiated prices with insurance companies. It delayed a decision in a final regulation released Friday.

Between the lines: Even if the Trump administration follows through and issues a price transparency rule, the industry almost certainly will sue to block it — meaning this policy is years away from seeing the light of day.

Go deeperArrowNov 4, 2019