CHA News Article

GAO Report Recommends Lowered Medicare Payments for Certain HOPD Services

The Government Accountability Office (GAO) released a report Dec.18 recommending that Congress pass legislation that would reduce Medicare payments for evaluation and management (E&M) services performed at hospital outpatient departments (HOPDs). The report recommends the payments match the levels paid to independent physician offices. GAO estimates that E&M services can cost between $58 and $86 more when performed at HOPDs, compared to independent physician offices, because services provided at HOPDs are reimbursed with both an E&M physician fee and a hospital facility fee. GAO believes that equalizing the Medicare payment disparity could save the Centers for Medicare & Medicaid Services (CMS) $1 billion to $2 billion per year. These GAO recommendations are consistent with MedPAC recommendations adopted in 2013. CHA remains opposed to efforts to reduce hospital outpatient payments to the equivalent of a physician payment rate, and will continue to work with the membership and national association partners to further prevent the erosion of hospital outpatient payments. 

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