PAI Report Outlines Payment Differentials Across Outpatient Settings

Payment-Differentials-ReportLast week, the Physicians Advocacy Institute (PAI) released a study prepared by Avalere Health entitled “Medicare Payment Differentials Across Outpatient Settings of Care,” that provides a comprehensive examination of Medicare payment rate differentials across service settings.

The report assesses the Medicare payment differential for three common services routinely performed in hospital outpatient department (HOPD) and physician office settings: echocardiograms, colonoscopies and evaluation and management services. The report confirms that for all three types of services, Medicare spends more when patients receive services in a HOPD instead of a physician office. For instance, the study found that cardiac imaging payments are more than triple when patients receive care at a hospital outpatient department instead of a physician’s office – roughly $2,100 vs. $655, respectively. Read the full report here.

Release of the report has garnered media coverage including this article published today in Health Leaders Media.

PAI is a not-for-profit advocacy organization whose mission is to advance fair and transparent payment policies and contractual practices by payers and others in order to sustain the profession of medicine for the benefit of patients. PAI’s Board of Directors includes CEOs and former CEOs from nine state medical associations, including California, Connecticut, Georgia, Nebraska, New York, North Carolina, South Carolina, Tennessee and Texas, as well as a Kentucky physician.

 
 

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