The recent legislative changes related to off-campus provider based clinics makes the likelihood of site-neutral payments a major challenge that hospitals and health systems must address.
The federal budget is one contributing factor, with the likelihood that concerns about deficits will make provider rates an easy target. Longer term, the advance of accountable care make it more likely as well.
Health systems have too much at stake to not actively assess the risks and act on that assessment. The current world includes provider based reimbursement, 340b, and incentives that relate to hospital based rates services. These issues at times distort provider decisions. For the purpose of this discussion, we are considering all vulnerable targets.