NEVADA (July 24, 2023) – To address rising health care costs that are straining government budgets and burdening patients, support for expanding site-neutral payments for Medicare continues to build in Congress. Most recently, a bipartisan bill titled the Site-based Invoicing and Transparency Enhancement (SITE) Act has been introduced by Senators Mike Braun (R-IN) and Maggie Hassan (D-NH). The bill has been referred to the Senate Committee on Finance, of which Nevada Senator Catherine Cortez Masto (D-NV) is a member.
Under current law, Medicare patients are being overcharged for health care services, such as routine office visits and lab work, at practices owned by hospitals. These services cost patients less when provided in an independent physician’s office. The Congressional Budget Office estimated that taxpayers will pay close to $40 billion in excess costs to Medicare due to exorbitant facility fee payments over the next decade.
This issue has become more prevalent as more physician-owned practices increasingly become acquired by larger hospital systems. Current law incentivizes hospitals to acquire private practices by allowing them to upcharge patients at the higher hospital rate. Therefore, the SITE Act seeks a site-neutrality policy of having Medicare pay the same amount for the same outpatient services regardless of whether the service is performed in a hospital, ambulatory surgical center, or physician’s office.
Recent polling shows that an overwhelming 94 percent of voters want Congress to take action to address high health care costs, while another poll shows that 85 percent of voters are supportive of limiting outpatient fees to the same price charged by doctors in the community. Further, site-neutrality has been a popular bipartisan platform initiative for Presidents Obama, Trump, and Biden.
Specifically, the SITE Act would:
- End exceptions to the 2015’s Bipartisan Budget Act site-neutral payment requirements, which exempted most facilities from fair billing requirements.
- Prevent off-campus emergency departments from charging higher rates than on-campus emergency departments when standalone emergency facilities are located in close proximity to a hospital campus.
- Require that health systems establish and bill using a unique National Provider Identifier number for each and every off-campus outpatient department.
- Direct HHS to treat outpatient departments as subparts of the parent organization and to issue these subparts unique provider identifiers.
- Remove liability for services rendered for payers that are not billed in accordance with this section’s requirements.
Patients across Nevada also face barriers to health care access due to staff shortages. Health care providers across the country are struggling to hire and retain qualified nurses to staff their facilities, and hundreds of thousands of new nurses will need to be trained over the next decade to meet our evolving health care workforce needs. The SITE Act would respond to these needs by reinvesting savings from this bill into a national nurse training program, which would:
- Create a graduate nursing education program to provide payments for qualified advanced practice registered nurse (APRN) training costs.
- Support a network of regional partnerships between hospitals, clinical training sites, and schools of nursing.
- Create 20,000 training positions per year, phased in over six years.
- Appropriate $100 million for the program.
A similar bill, titled the Facilitating Accountability in Reimbursements (FAIR) Act, has also been introduced in the House of Representatives by Representatives Kevin Hern (OK-01) and Annie Kuster (NH-02).
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