WASHINGTON — A bipartisan group of four senators introduced a bill Wednesday that would cap what hospital-owned outpatient clinics can charge for infused drugs, such as chemotherapy and treatments for autoimmune disease, at the rate paid to independent doctors’ offices.
The gap can be large. For the same infusion of the same drug, hospital outpatient departments are often paid two to three times what a physician’s office receives, according to an analysis by the Senate committee staff. Some of that difference comes from facility fees, which hospitals charge to cover overhead.
The bill would apply to private insurance plans as well as Medicare. Its sponsors estimate it would save patients and employers about $9 billion a year, though the Congressional Budget Office has not yet scored it.
Who is for it, and who isn’t
Employer groups and patient advocates support the bill. They say hospitals have bought up independent cancer and infusion practices over the past decade, then raised prices simply by changing the billing address.
The main hospital trade group opposes it. In a statement, it said facility fees pay for «around-the-clock staff, emergency backup and safety standards that a private office doesn’t carry,» and that the cap could force some rural hospitals to close infusion centers.
The bill has a long road. A similar proposal limited to Medicare stalled in committee two years ago. One Senate aide involved in drafting the new version said the sponsors are hoping to attach it to a larger health package in the spring.
What it would mean for patients
For patients with commercial insurance and a deductible, the price of an infusion directly affects what they owe. Under the bill, a patient who now pays $1,400 toward a hospital infusion could pay closer to $600 at the same clinic, according to one example in the committee’s analysis.