Impact

Services performed in the physician office setting that have high supply, device, and/or equipment costs and low labor costs will experience significantly reduced payment.  In many cases, payment is less than the actual cost of the supply, device, or equipment.  As a result, it is becoming increasingly  financially unfeasible to offer patients these services in the office setting, and physicians will be forced to perform these services in more costly settings, such as the HOPD or ASC.

• Office-based treatment represents a less expensive and higher quality setting for many procedures
  • Medicare payment is higher for a service performed in the HOPD or ASC setting compared to the office setting

• Office-based treatment is more accessible and less expensive for patients
  • A patient’s coinsurance will be higher due to higher payment rates in the HOPD and ASC settings compared to the office setting
  • Patients are familiar with physician offices as they are visited regularly

• If payment does not cover actual costs, physicians may not offer these services to the patient

The coalition is conducting research to develop remedies with minimal impact on the Medicare Trust Fund that would solve the current PFS policy that effectually denies access to valuable office-based treatments.  Our team includes data experts, reimbursement strategists, and professionals experienced in working with CMS and Congress.