Outpatient Departments Treat Sicker & Lower-Income Patients Than Other Sites of Ambulatory Care

A new study released  by the American Hospital Association (AHA) shows that Medicare patients who receive care in a hospital outpatient department (hospital outpatient department) are more likely to come from medically underserved populations and be sicker and more complex to treat than Medicare patients treated in independent physician offices (IPO) and ambulatory surgical centers (ASC).  

According to today’s study, relative to those seen in an IPO or ASC, Medicare patients seen in HOPDs are more likely to be:

• Lower-income;
• Non-white;
• Eligible for Medicare based on disability and/or end-stage renal disease;
• Burdened with more severe comorbidities or complications;
• Dually-eligible for both Medicare and Medicaid;
• Previously cared for in an emergency department or hospital setting.

“Hospitals and health systems provide around-the-clock care — including emergency services — to all who come to us. This includes the sickest patients and those left behind economically in our communities,” said AHA President and CEO Rick Pollack. “Medicare already reimburses hospitals, which have more comprehensive licensing, accreditation and regulatory requirements than independent physician offices and ambulatory surgical centers, less than the cost of providing care.”

The findings of this new study, conducted for the AHA by KNG Health Consulting, underscore the reasons why compensating hospitals and health systems under Medicare the same amount as IPOs and ASCs could put patient access to care at risk. Proposals under consideration by policymakers to do so — often referred to as “site-neutral” payment policies — fail to recognize the legitimate differences in the types of services hospitals provide — as well as the types of patients hospitals serve — compared to other providers. Unlike other providers, hospitals maintain standby capacity for natural and man-made disasters, public health emergencies, other unexpected traumatic events, and the delivery of 24/7 emergency care to all who come through their doors, regardless of a person’s ability to pay or insurance status.

AHA survey data has found that the federal government only paid 84 cents for every dollar hospitals spend providing care to Medicare beneficiaries.

For a full copy of today’s study, visit https://www.aha.org/guidesreports/2023-03-27-comparison-medicare-beneficiary-characteristics-report.