Wyden pressed to act on site-neutral payments


June 12, 2024 3:01 pm

Families USA is leading a new lobbying push for Senate action on site neutral payment reforms, pressing Finance Committee Chair Ron Wyden to follow through on an issue House Republicans addressed in their transparency bill.

Why it matters: Changing how Medicare pays hospitals for outpatient care is a tough sell in the Senate, so pressure from a key consumer group is important to keeping the issue alive.

Driving the news: Families USA and a range of groups including AFSCME are calling on Wyden and Finance ranking member Mike Crapo to hold a hearing before the August recess on health care affordability and hospital costs.

What they’re saying: Wyden told Axios on Tuesday he is “not up on the letter” from the groups. Speaking about site neutral in general, he said: “I’ve had lots of people talking to me about it. I’ve got to get more input with respect to the rural areas.”

Our thought bubble: A Finance hearing is highly unlikely before the August recess, but the real hope is to keep the issue on the table for a year-end health care package.

  • It is also notable that Families USA, a nonpartisan consumer group often aligned with Democrats on issues like the Affordable Care Act, is pressuring a Democratic chair on hospital costs, and finds itself more aligned with House Republicans than Senate Democrats on this issue.

Between the lines: The letter calls for two policies that already passed the House as part of its bipartisan transparency bill.

  • One is site neutral payments for physician-administered drugs , which backers say would save the sickest chemotherapy patients over $1,000 per year. The policy would pay the same amount for the service regardless of whether the drugs are delivered in a hospital-owned or independent facility.
  • The second ask is requiring hospital outpatient departments to have unique identifier numbers to toughen up on what critics call “dishonest billing” and ensure they are being paid the correct amount.

The intrigue: Besides Wyden’s worries about rural areas, Senate Majority Leader Chuck Schumer, an ally of New York hospitals, also has concerns with both policies, as we previously reported.

The bottom line: Even these relatively small steps on hospital costs face major hurdles in the Senate amid hospital industry opposition.