Identical Care | Incompatible Cost.
In a recent Houston Chronical article, The sneaky reason American medical bills are rising, Dr. Audrey Nath, a neurologist, writes “People seeking the health care they need to live and thrive shouldn’t be charged differently just because of where they receive care.”
Dr. Nath skillfully explains how consolidation – hospitals buying other hospitals and health systems purchasing independent physician practices – impacts patients, especially those with complex, chronic medical needs. The immediate consequence of consolidation is less patient care in a doctor’s office and more care at hospital-owned outpatient departments. Since Medicare allows hospital-owned medical practices to charge significantly more than an independent physician practice for the same services, hospitals continue “to buy up independent doctors’ practices, slap a new sign on the front and start charging more” Nath explains.
Real world examples of these payment differences include patients with rheumatoid arthritis paying $30 for a steroid injection to relieve pain in their knuckles when it is administered in a physician practice and being billed $1,394 for the same injection when received at a hospital-owned rheumatology clinic. That’s a price increase of over 4,500%. An hour of chemotherapy infusion costs $129 in a physician-owned cancer treatment center and $333 (158% more) for identical treatment in a hospital-owned center. Cost of radiation therapy (SBRT) delivery is $994 in a community-based cancer center and $1,767 in a hospital outpatient department; a 78% difference for the same care, same technology and same equipment. In addition to increasing total Medicare spending, these costs mean higher out-of-pocket costs for patients as Medicare beneficiaries typically pay 20% of the total cost in coinsurance.
In an effort to chip away at incompatible costs for identical care, H.R. 4473, the Medicare Patient Access to Cancer Treatment Act was introduced. It would equalize payments for cancer care services across all sites of service and ensure that cancer patients pay the same amount for the same service regardless of where they receive it. Join with Patients and Providers United to call on Congress to preserve access to community based cancer care providers.