CMS’s 2019 Plan Could Even the Playing Field for Nonhospital Urgent Care Centers

The Centers for Medicare & Medicaid Services says it wants to stop paying hospital-based clinics more than they pay physician offices for the same level of care administered to Medicare patients. Calling it a “site-neutral plan for clinic visits,” CMS proposes lowering reimbursements for hospital outpatient departments to match what it pays on the physician fee schedule for clinic visits. According to figures released by CMS, right now Medicare pays roughly $116 for a visit to an outpatient hospital department, compared with $46 for a visit to a physician’s office. The proposed change would be part of the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for 2019. Clinic visits are the most common service billed under OPPS. The Association of Independent Doctors has “heartily” endorsed the concept, predicting that it could save $760 million a year in healthcare spending.