Site-neutral payment—paying the same price for the same service no matter where it is provided—has been proposed by the Medicare Payment Advisory Commission (MedPAC) and others for a number of post-acute and ambulatory services furnished to Medicare beneficiaries. It is a concept that has also gained traction among private insurers who balk at paying more for services delivered in the offices of physicians whose practices have been acquired by hospitals or health systems. When care is delivered in more costly settings, the Medicare program and private insurers typically end up paying more, as do beneficiaries and patients due to higher copayments. But some argue that higher payments to hospitals and other institutions, such as inpatient rehabilitation facilities, are justified because these facilities have higher overhead costs associated with meeting regulatory requirements and providing valued services such as emergency care, standby capacity, etc. Both sides agree that the lack of comparable patient assessment data to determine which patients receive identical services makes implementation of site-neutral payments challenging. This Forum session provided an overview of MedPAC's findings and recommendations regarding site-neutral payments for post-acute and ambulatory services and looked at the issue from the perspectives of an insurer, post-acute care provider, and acute care hospital.
Mark E. Miller, PhD (bio)
Executive Director, Medicare Payment Advisory Commission
Donald Fischer, MD, MBA (bio)
Senior Vice President & Chief Medical Officer, Highmark Inc.
Gerben DeJong, PhD, FACRM (bio)
Senior Fellow for Health Policy & Post-acute Care, MedStar National Rehabilitation Hospital
Professor, Department of Rehabilitation Medicine, Georgetown University School of Medicine
Michael Sack, MSPH, FACHE (bio)
Former President & Chief Executive Officer, Hallmark Health System (Massachusetts)
Mark E. Miller, Medicare Payment Advisory Commission, "Medicare Fee-for-Service Payment Policy Across Sites of Care," statement before the Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives, May 21, 2014.
Reginal Coopwood, "Keeping the Promise: Site-of-Service Medicare Payment Reform," testimony of the American Hospital Association before the Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives, May 21, 2014.
Gerben DeJong, "Site-Neutral Payment for Postacute Care: Framing the Issue," Archives of Physical Medicine and Rehabilitation, 95 no.6 (June 2014): pp.1212-1216.