Community-Based Care Must Remain Accessible

Patients prefer care that is high quality, close to home and cost effective. That is exactly the type of care that community-based providers deliver and why maintaining access to them is necessary. A federal commission that looks at accessibility found that Medicare patient copays were approximately 3 times higher at hospital-owned sites than at independent, community-based physicians’ offices for identical patient care. This costs Medicare beneficiaries as much as $380 million more in out-of-pocket payments. For commercially insured patients, an analysis by the American Journal of Managed Care found a patients receiving care in hospital-owned sites paid between 1.06 and 2.94 times what they would have paid in a physician office for that same service.

One reason behind the higher costs for identical care at hospital-owned sites is the opaque facility fee that hospitals tack on to every patient’s bill. Kaiser Health News features a story of a patient getting blindsided by hospital bill for an outpatient biopsy procedure. The cost for the biopsy, ultrasound, physician charges and lab tests we’re $1,250, the hospital facility was over $2,100. The Kaiser Health News piece concludes with “The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done… Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.”

Regulations that threaten the viability of community-based care jeopardize patient access to care close to home, strip patients of choice among providers and increase patients’ out of pocket costs. Join with Patients and Providers United to preserve access to community-based care by telling policymakers to reject untested schemes that endanger it.