AHA Advocacy Alliance for Coordinated Care

The Medicare Payment Advisory Commission (MedPAC) adopted a policy in 2012 that would cap "total" payment for non-emergency department evaluation and management (E/M) services in hospital outpatient departments (HOPDs) at the rate paid to physicians for providing the same services in their offices.  The AHA strongly opposes this policy to equalize Medicare payment rates for E/M services between hospital outpatient departments and physician office settings. Hospital outpatient departments provide access to critical hospital-based services that are not otherwise available in the community and treat higher-severity patients for whom the HOPD is the appropriate setting. In addition, they have higher cost structures than physician offices due to the need to have emergency stand-by capacity and higher costs associated with a myriad of regulatory requirements those facilities must legally meet. The AHA Advocacy Alliance for Coordinated Care will focus on ensuring payment rates remain fair and equitable in the hospital outpatient setting for E/M and other services and for post-acute care providers.  It also will monitor payment reduction proposals in other care sites.

TOOLS AND RESOURCES

   AHA RESOURCES

Coordinated Care Alliance Call Briefings: Click here for audio recordings and more information

• AHA Factsheet: Outpatient Evaluation & Management Services
• AHA Issue Paper: Outpatient Evaluation & Management Services
  
• AHA to MedPAC Re: Medicare Payment Rate Differences Between HOPDs and Freestanding Physician Offices
• AHA to MedPAC Re: final payment recommendations for fiscal year (FY) 2013

   OTHER RESOURCES

• MedPAC Report to Congress, March 2012 

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