For every $1 hospitals spend on Medicare patients, the government pays only 84 cents, research from the American Hospital Association found.
On top of that, Medicare beneficiaries who get care at a hospital outpatient department are more likely to have severe comorbidities and belong to groups that experience health inequities.
"The findings of this new study, conducted for the AHA by KNG Health Consulting, underscore the reasons why compensating hospitals and health systems under Medicare the same amount as [independent physician offices] and ASCs could put patient access to care at risk," the organization wrote in a March 27 statement.
The research analyzed Medicare beneficiary characteristics and compared them to those who were treated in different ambulatory settings between 2019 and 2021. The findings revealed that Medicare beneficiaries seen in a hospital outpatient department were nearly twice as likely to also be eligible for Medicaid than those who were seen at independent physician offices.
Additionally, hospital outpatient departments were also more likely to serve a higher proportion of nonwhite cancer patients and individuals who are from lower socioeconomic backgrounds than physician offices. These departments also saw patients who were more likely to have a complication or comorbidity and were more likely to have had a prior hospital visit within the last 90 days compared to ASCs.
"While there is overlap in the types of services provided across settings, our findings indicate that beneficiary needs, and — as a result — treatment costs may differ across settings due to variation in clinical factors and social determinants of health," AHA researchers wrote. "Our findings suggest greater capabilities of hospital-based settings as well as disparities in health care access by different beneficiaries. Such factors should be considered by policymakers when assessing changes to Medicare policies."