The U.S. Congress returned last week to try to wrap up its work before the newly elected Congress is sworn in next month. This return – known as the “lame-duck” session – has important topics on its to-do list. Among the most critical items is to try to agree on funding for the federal government – at least through the winter – providing more disaster aid, approving a defense policy bill, confirming judges, and hopefully, taking on some important health care measures.
The term “lame-duck” session of Congress refers to the period when the Congress meets after its successor is elected, but before the successor’s term begins. And that period is now.
The most important action for the lame-duck is for Congress to approve continued government funding, since lawmakers only have until December 20th before the existing funding runs out. Passing a budget was not the first item to be tackled, however. The U.S. Senate leadership agreed to a deal to allow confirmation of some of President Biden’s judicial nominees.
Top issues are replenishing the Federal Emergency Management Agency’s disaster relief fund and agreeing on funding of the defense department, with other potential topics including measures that impact health policy.
While it remains to be seen how much legislative activity occurs during the lame-duck, one of the possibilities is a measure known as “site neutral” health care payments.
Last month, nearly 60 organizations joined the call to urge Congress to pass legislation that would require that hospital and non-hospital Medicare pricing be the same.
Here is the background: The amount charged for medical procedures or services can depend as much on where they are performed as on the type of procedure or service provided. All else being equal, a procedure in a hospital is much more expensive than that same procedure done in a freestanding facility like a physician’s office or a clinic. The higher cost is meant to support a hospital’s more complex infrastructure, staffing and other expenses.
However, these higher prices are being charged for services provided at non-hospital locations, which often operate at less expense. That’s in large part because hospitals are buying up private practices, clinics, imaging centers and labs, using them effectively as a “cash cow” to charge more. Once acquired, these facilities often begin using the hospital billing code to charge hospital prices for services that were previously less expensive. When acquired by a hospital, physician practices charge about 14 percent more than when they were independent. That means patients and insurers begin to pay more for the same service. The only difference is that the non-hospital facility is owned by a hospital and begins to use the hospital billing code. And over half of physicians now work for hospitals and health systems.
As a result, patients, Medicare, and employer-based insurance companies are paying much higher prices for care than they otherwise would. For example, Medicare pays twice as much for procedures done in hospital-owned facilities as they would in independent physician’s offices. Don’t forget that for many patients, high deductibles and co-insurance policies mean that they may face a financial hit as well.
The “site neutral” legislation that would be considered in the lame-duck requires that Medicare procedures and services are delivered at the same price regardless of the location, whether it’s a hospital, doctor’s office, imaging center or clinic. This would save significant money for consumers, employers and taxpayers. Decreased Medicare spending as a result of “site neutral” policies could save taxpayers $150 billion.
Those savings drove the House of Representatives to approve legislation that contained a “site neutral” provision. In the U.S. Senate, Republican Senator Cassidy and Democratic Senator Hassan have released a legislative framework for “site neutral” payment policy. Their proposal could be the vehicle for action during the lame-duck.
Of course, whatever happens during the lame-duck will have to be the product of bipartisan compromise. Given the existing narrow Democratic Senate majority, which is soon to be replaced by a Republican one, the parties will have to agree to get anything done at all.
Yet, the bipartisan nature of the Cassidy/Hassan plan, coupled with the apparent support in the House, indicates “site neutral” legislation has a chance. The prospects for success hinge on whether it’s a priority of current Senate Majority Leader Schumer. Here’s hoping he’s able to get it done.