News: Hospital outpatient departments treat sicker and lower-income patients, AHA study reveals

In a recent survey released by the American Hospital Association (AHA), data shows that Medicare patients who receive care from a hospital outpatient department (HOPD) are more likely to be sicker, come from medically underserved populations, and be more complex to treat than Medicare patients who receive care in independent physician offices (IPO) and ambulatory surgical centers (ASC). Using claims data, researchers compared Medicare beneficiary characteristics between patients treated in these different ambulatory settings from 2019 to 2021.

On average, beneficiaries seen in HOPDs were 30% more likely to have CCs and almost twice as likely to have MCCs than those seen in IPOs. HOPD patients also had higher emergency department (ED) and hospital utilization than ASC and IPO patients; in the prior 90 days, those seen in HOPDs were 2.8 times more likely to visit an ED and 3.6 times more likely to have received inpatient hospital care.

Compared to Medicare patients seen in an IPO or ASC, those seen in HOPDs were more likely to be:

• Lower income
• Nonwhite
• Eligible for Medicare based on disability and/or end stage renal disease
• Dually eligible for both Medicare and Medicaid

“Hospitals and health systems provide around-the-clock care—including emergency services—to all who come to us. This includes the sickest patients and those left behind economically in our communities,” said AHA President and CEO Rick Pollack in an AHA press release. “Medicare already reimburses hospitals, which have more comprehensive licensing, accreditation and regulatory requirements than independent physician offices and ambulatory surgical centers, less than the cost of providing care.”

Pollack suggested that these findings underscore why compensating hospitals and health systems the same amount as IPOs and ASCs under Medicare may risk their patients’ access to care. He emphasized the importance of hospitals in giving all types of services to their communities that other providers don’t, pointing out that AHA survey data has found the federal government already pays only 84 cents for every dollar spent by hospitals to care for Medicare beneficiaries.

Editor’s note: To read the AHA press release, click here. To access the full study, click here.