** UPTA Policy Proposal: Achieving Site-Neutral Payments to Reduce Costs, Protect Medicare, and Empower Independent Practitioners**
Background
The current healthcare reimbursement model in the United States creates significant disparities in payments for the same services based on the location where care is delivered. Hospital-owned outpatient facilities are often reimbursed at significantly higher rates than independent practitioners for identical services. This inequity drives up healthcare costs for consumers, accelerates the depletion of Medicare funds, and threatens the viability of independent practices that are essential for accessible, community-based care.
The Problem
- Higher Costs for Consumers
The lack of site-neutral payments leads to inflated healthcare costs. When services are performed in hospital-owned facilities, patients frequently face higher copays and deductibles, adding financial strain to families and individuals. - Depleting Medicare Funds
Medicare reimburses hospital-owned facilities at higher rates for the same services provided by independent practices. This inefficiency drains Medicare resources, accelerating the program’s financial instability and threatening its long-term sustainability for seniors. - Erosion of Independent Practices
Higher reimbursement rates for hospital-owned facilities incentivize hospital systems to acquire independent practices. This consolidation reduces competition, limits patient choice, and drives independent practitioners out of business, leaving patients without affordable, community-based care options.
Policy Proposal
To address these challenges, The ** United Physical Therapy Association** advocates for a comprehensive move toward site-neutral payments:
- Equal Reimbursement for Equal Services
Mandate that Medicare and private insurers reimburse the same rate for a service regardless of whether it is provided in a hospital-owned outpatient facility or an independent practitioner’s office. - Transparency and Accountability
Require hospital systems and insurers to disclose costs associated with site-of-service differentials, empowering consumers to make informed decisions and encouraging fair pricing practices. - Protections for Independent Practices
Implement policies to support independent practicess during the transition to site-neutral payments, including grant programs, tax incentives, and streamlined regulatory requirements.
The Benefits of Site-Neutral Payments
- Lower Healthcare Costs for Consumers
Patients will face lower out-of-pocket expenses, reducing financial barriers to accessing care. - Preservation of Medicare
By eliminating overpayments to hospital-owned facilities, Medicare funds will stretch further, ensuring the program remains viable for future generations of seniors. - Support for Independent Practitioners
Equalizing payments will restore a level playing field, allowing independent practices to compete fairly and remain viable, ensuring patient choice and access to localized care.
Call to Action
The time to act is now. Site-neutral payments are a common-sense solution that reduces costs, protects Medicare, and sustains the backbone of our healthcare system: independent practitioners. The United Physical Therapy Association calls on lawmakers, healthcare providers, and patients to support this crucial reform to build a more equitable and sustainable healthcare system for all.