Illustration: Natalie Peeples / Axios
The Trump administration is going where Congress wouldn't last year, embracing site-neutral hospital payment policies as part of a 2026 Medicare payment rule.
Why it matters: Changes to the way hospitals are paid for outpatient procedures have been touted for years as a way to save taxpayers and patients money.
- But health systems say the policy change would lead to damaging cuts that would especially harm rural areas.
- Several site-neutral plans were debated in Congress last year, but the issue never made it into an envisioned year-end health deal.
What's inside: CMS on Tuesday proposed to pay the same rate for some services regardless of whether they're delivered in hospital outpatient facilities or doctors' offices. Hospitals typically bill Medicare more for the same services.
- The agency wants to reduce the amount it pays hospitals to administer outpatient drugs, including chemotherapy, in off-campus facilities, so that the sum is the same as what physicians in private practice are paid.
- This year, Medicare is paying physician offices around $119 for a chemotherapy infusion, while off-site hospital outpatient facilities collect about $341, the proposal says.
The American Hospital Association opposes the change, arguing that outpatient departments are likelier to serve patients who are sicker, have more complex cases and live in poor or outlying communities than patients treated in independent physician offices.
- The CMS rule would also beef up hospital price transparency rules through steps like requiring facilities to post actual prices instead of estimates and provide pricing data in standardized formats.
What's next: The rule is open for public comment for 60 days.
