Fighting against cuts to hospital-based clinics

September 1, 2016

Access to care continues to be a paramount goal for WSHA in support of our member hospitals and health systems. When Medicare and Medicaid patients are seen at a hospital-based clinic, the clinic receives a higher payment for its services than a traditional physician’s office would. These payments are crucial, as hospital-based clinics have more regulatory requirements and see more Medicare and Medicaid patients, while many community physicians are limiting their panels.

However, for years lawmakers have questioned whether these higher payments are necessary. Payments are now at risk for adoption of “site neutral” policies that disregard whether a facility is hospital-based. For example, the 2015 Bipartisan Budget Act prohibits new off-campus provider-based clinics from receiving hospital-level payment for infrastructure. This was a surprise move that creates grave concerns for the future sustainability and access to care for Medicare and Medicaid patients.

Short-term next steps. During the August recess, WSHA had meetings with key members of our congressional delegation, and opposing site neutral policies was at the top of our list of issues. We are taking a group of rural hospital leaders to Washington, D.C., for Rural Advocacy Days in two weeks. We plan to spend significant time making sure our congressional delegation hears about the impact on patients, and asking for modifications to the new payment policy. We also urge hospitals to submit comments, similar to WSHA’s, urging CMS to delay and maximize flexibility in its implementation.

The future: Now is the time to band together and be on record. Hospital and health systems are at risk for other site neutral policies that strip funding. In the near future, we could see another congressional budget deal proposing to eliminate the additional hospital-based payment for existing clinics, or cuts to targeted areas, such as ambulatory or surgical services. We need to step up our advocacy efforts this fall to ensure our delegation understands the impact of the 2015 budget deal and why our hospitals cannot afford expansion of site neutral policies without a real discussion on the issue at hand: Medicare fee-schedule payment rates don’t cover the cost of care.

We also know that it will be a topic in the upcoming state legislative session. WSHA and its members will continue to demonstrate the need for hospital-based payment to ensure access to needed services for Medicare and Medicaid patients. Now is the time to be on record with your federal and state elected officials!

Chelene Whiteaker
WSHA Policy Director, Member Advocacy


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