One of the most abused and most absurd practices in our health care system is that the exact same treatment may be reimbursed at extremely different levels depending on whether it occurs in a doctor’s office, a hospital outpatient department, a surgery center or some other site. Payers have tried for a long time to fix this, with great resistance from hospitals in particular. A brief from the Employee Benefits Research Institute illustrates this issue for company health plans in regard to one of the most-abused treatments–specialty medications. The report finds that hospital outpatient departments are charging far more for these drugs and their administration than is charged in other settings. Literally billions of dollars could be saved by payers if the hospitals were forced to take the same pay as a doctor’s office for example, as hospitals on average were charging 100% for the same medication.
The only explanation for why this hasn’t been fixed is hospital abuse of market power and their campaign contributions to cowardly politicians. (EBRI Report)
