LUGPA Escalates its Fight for Site-Neutral Payments

February, 2020 

Continuing our ongoing efforts as advocates for site-neutral payments, the LUGPA Board approved the development of an amicus curiae brief in support of the HHS Secretary’s action to cap rates for hospital clinic visit services in the off-campus outpatient department setting.

On January 30, an amicus curiae brief was filed in the United States Court of Appeals for the District of Columbia on behalf of LUGPA and two other stakeholders, the Digestive Health Physicians Association and the OrthoForum. Together, the three associations represent the interests of nearly 8,000 physicians caring for millions of Medicare beneficiaries in the independent practice setting in urology gastroenterology and orthopedics.

Independent practices provide many of the same services as hospital outpatient departments, however, Medicare pays independent practices less than the amount paid to hospitals for the same services provided in their off-campus outpatient departments. Health and Human Services Secretary Alex Azar recognized that beneficiaries could receive the same services in an independent setting at a lower cost to Medicare and its beneficiaries. HHS subsequently issued a directive to cap rates for clinic visit services in the off-campus outpatient department setting. This action is pursuant to the mandate in the Medicare Act that the Secretary employ a method to control the unnecessary increase in the volume of outpatient delivery services.

LUGPA and its stakeholder partners are likely to be the only filers supporting Secretary Azar’s action. LUGPA continues to be the leading advocate on behalf of independent urology groups and has long recognized that payment disparities across different sites of service hurts patients and physicians in independent practices. 

Read the full brief here.