Study: Hospital Outpatient Departments Treat Poorer/Sicker Patients

April 16, 2019

The findings of a new study conducted for the American Hospital Association found that Medicare patients treated in hospital outpatient departments (HOPDs) are more likely to be poorer, have severe chronic conditions, and have been previously hospitalized than Medicare patients treated in an ambulatory surgical center (ASC). The study concludes that due to their medical complexity, HOPD patients may require a greater level of care than ASC patients.

This study comes at a time when Medicare proposals under consideration by policymakers in Washington, D.C., would compensate HOPDs and ASCs the same amount, failing to recognize the differences in the types of services provided by HOPDs and the patients they serve. Currently, Medicare pays HOPDs, which have more comprehensive regulatory requirements than ASCs, less than the cost of providing care. In Wisconsin, for instance, Medicare reimburses HOPDs roughly 75% of the cost of providing care. WHA has emphasized to policymakers that further reducing reimbursement would threaten access to care for patients who, according to the study, are more likely to be disabled, 85 or older, from lower-income areas, Black or Hispanic, and burdened with more severe chronic conditions.

View a copy of the study, which was conducted by KNG Health Consulting, LLC.

This story originally appeared in the April 16, 2019 edition of WHA Newsletter