LUGPA Victory: SCOTUS Ruling regarding Site-neutral Payments

June 28, 2021
LUGPA is extremely pleased to inform you that today, the Supreme Court of the United States (SCOTUS) affirmed LUGPA’s position with respect to site-neutral payments for evaluation and management (E/M) services in the hospital outpatient (HOPD) setting. 

At issue was the American Hospital Association’s petition for the court to rule in the matter of AHA v Becerra (CMS), a lawsuit challenging CMS policy that established a transition to site-neutral payments for specified off-campus HOPD E/M services. This policy, strongly supported by LUGPA, was established in 2019 when CMS identified that permitting higher payments to hospitals for identical services greatly increased Medicare system costs. The AHA filed suit to overturn this policy, but CMS prevailed in a ruling by the U.S. Court of Appeals for the District of Columbia Circuit. In response, the hospital industry appealed the policy to the SCOTUS. By declining to review the lower court decision that upheld the CMS policy, that policy remains in effect, benefiting the Medicare program and its beneficiaries. A full summary of the ruling can be found here.

Hospitals and health systems have exploited payment differentials to aggressively acquire physician practices, limiting access to care and increase costs to the Medicare program and more importantly, to patients. Advocating for site-neutral payments has been a cornerstone of LUPGA’s advocacy programs, which included efforts by both LUGPA’s Political Affairs and Health Policy apparatus both by meeting with and providing important data to key legislators and regulatory bodies. Importantly, LUGPA was the only national urology society that supported CMS during litigation by filing amicus curiae briefs to both the U.S. Court of Appeals and SCOTUS; the ruling today represents the culmination of years of work by LUGPA on behalf of independent practices.

“We believe the Supreme Court made the right decision to reject the hospital industry’s challenge to the site-neutral payment rule. The court’s denial of the American Hospital Association’s petition sends a clear message the argument had no merit, and more importantly, it’s an acknowledgment of the value of independent practices as a crucial counterbalance to monolithic health care systems. Though this is an encouraging development, LUGPA members will remain focused on engaging Members of Congress to support legislation which continue to level the playing field for independent physicians to fairly compete with hospitals systems to increase quality and access to care for all Medicare patients across the country,” said LUGPA President, Jonathan Henderson, MD.