NATIONAL HARBOR, Md. -- Site-neutral insurance payments are a good idea, American Medical Association (AMA) delegates agreed on Monday during their interim meeting here.
Currently, Medicare and other insurers pay physicians more for certain services if they are performed in a hospital, and pay less for the same procedures performed on outpatients, rather than paying the same amount regardless of the site of care. Monday's vote on the issue came after a discussion Sunday at an AMA reference committee meeting, in which delegates generally agreed that making payments site-neutral would help private practices survive financially at a time when many physician groups are being bought out by hospital systems.
Delegates approved a report by the AMA's Council on Medical Service that recommended that the AMA "support Medicare payments for the same service routinely and safely provided in multiple outpatient settings (e.g., physician offices, hospital outpatient departments, and ambulatory surgery centers) that are based on sufficient and accurate data regarding the actual costs of providing the same service in each setting."
The report also reaffirmed previous AMA policies on this issue; one policy "calls for equity of payment between services provided by hospitals on an outpatient basis and similar services in physicians' offices," the Council on Medical Service noted in its report on the matter. In addition, "AMA policy also supports defining Medicare services consistently across settings and encouraging the CMS [Centers for Medicare & Medicaid Services] to adopt payment methodologies that assist in leveling the playing field across all sites of service," the council said.
Delegates also agreed to reaffirm AMA policies that "encourage CMS to expand the extent and amount of reimbursement for procedures performed in the physician office, to shift more procedures from the hospital to the office setting ... and direct the AMA to aggressively promote the compilation of accurate data on all components of physician practice costs," as advocated by the council's report.
Delegates rejected a suggestion by Stephen Rockower, MD, of Rockville, Md., to refer the report to the board of trustees for further discussion. "There are accounting problems that can happen" when people try to tally up the costs involved in providing a particular service, Rockower said in explaining his proposal. "I would prefer ... to get proper accounting input to get the proper wording to make it [correct]."
But Charles Wilson, MD, a delegate from Greenville, N.C., disagreed. "I believe the council got it right," he said. "There will be further tweaks of this issue as time goes on, but right now this is quite adequate."
Steve Kanig, MD, a delegate from Albuquerque, N.M., speaking for the New Mexico delegation, agreed, pointing out that CMS is currently considering regulations on site-neutral payment. "This is a timely and urgent matter ... and we really don't want to put off further consideration of this report," he said.
The delegates also said No to a sentence added by the reference committee suggesting that "Site-neutral payments should be based on the actual costs of providing those services and not defined as equal payments or reducing all payments to the lowest amount paid in any setting."
"I speak against this amendment," said Andrew Kleinman, MD, of Rye Brook, N.Y., on behalf of the New York delegation. "Although the intent of the amendment, I think, is admirable, the actual effect could be the opposite of what was intended and could actually increase the difference and increase the amount a hospital would get as opposed to a physician's office."
In other results from Monday's session, AMA delegates also:
- Approved a resolution asking AMA to continue advocating for the rejection of step therapy in Medicare Advantage plans
- Rejected a resolution asking AMA to advocate for correction of underpayments by public and private payers for office-based DXA tests
- Approved a resolution asking the AMA to educate state and federal policymakers and legislators on, and advocate for policies addressing, the medical spectrum of gender identity to ensure access to quality healthcare
- Approved a resolution opposing FDA's decision to approve Primatene Mist HFA for over-the-counter use
A resolution on developing sustainable solutions to discharge of chronically homeless patients was referred to the board of trustees for further consideration. The reference committee that considered the resolution noted that it heard mixed testimony on the resolution, and that "speakers stressed that the resolution could have unintended consequences and amount to an unfunded mandate."