Study: Medicare outpatients sicker, have lower incomes than patients treated by physicians’ offices
Wednesday, October 10, 2018
Medicare patients who receive care in a hospital outpatient department are likely poorer and have more severe, chronic conditions than Medicare patients treated in independent physician offices, a study by the American Hospital Association (AHA) found.
The findings of this study seem to show why proposals under consideration by Congress to reimburse hospitals the same amount as physicians’ offices "could threaten access to care for the most vulnerable patients and communities," the AHA said in a statement.
The study also examined the characteristics of Medicare cancer patients seen in hospital outpatient departments and independent physician offices and found similar results. According to the study, Medicare patients — including cancer patients — seen in hospital outpatient departments are more likely to be from lower-income areas; under 65 (individuals with disabilities, end-stage renal disease and amyotrophic lateral sclerosis); face more severe chronic conditions; have previously been hospitalized; are eligible for both Medicare and Medicaid; and previously cared for in an emergency department so have higher Medicare spending prior to receiving ambulatory care.
Hospitals are held to far higher regulatory standards because of the complexity of caring for these higher acuity patients, the AHA notes.
"America’s hospitals and health systems are proud to provide care and emergency services 24/7 to all who come through the door regardless of their ability to pay," said AHA President and CEO Rick Pollack in a statement. "But as this study clearly shows, the needs of the patient’s hospital outpatient departments care for each day are different from those who choose to be seen at an independent physician office. Proposals that treat them the same ignore the very different clinical and regulatory demands hospitals face, and could threaten access to care."
According to the study, 28 percent of the hospital visits involved a prior emergency department visits, versus 17 percent of physician office visits. The share of hospital versus physician office visits with a prior short-term acute care hospital stay was 17 percent and 9 percent, respectively. That figure increased to 19 percent of hospital visits when the Medicare beneficiaries were cancer patients.
Hospital patients who spent time in hospitals had longer and more expensive stays than their physician office counterparts — 7.37 days at $20,108 versus 5.2 days at $14,686. The stays and costs were roughly the same for patients with cancer.
Per separate reports, the study comes as the Center for Medicare and Medicaid Services (CMS) proposes making payments for clinic visits site neutral, meaning hospital outpatient department visits would be reimbursed the same as doctor office visits. The proposed rule is expected to save Medicare $610 million annually, reduce beneficiary copays, and may cut down on providers' reporting requirements and raise payments by 1.25 percent, which the agency maintains will offset any reductions to hospitals.
Physician groups say they support the move based on the idea that the proposal might prevent hospitals from passing on facility fees to hospital outpatient department patients. But, apparently hospital groups believe CMS would ignore "the realities that hospitals face in serving the broad needs of their communities."
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