| |  | Industry Rx | Hospital leaders largely stuck to a familiar defense: rising costs, complex patient populations and regulatory burdens drive pricing decisions, rather than an effort to maximize earnings. “But how can you justify facility fees on outpatient facilities when there is no meaningful difference in the care delivered or quality of care?” asked Rep. Greg Steube (R-Florida) asked the panel of executives. Steube was among the many lawmakers who touched on the issue of hospitals purchasing independent physician practices and turning them into outpatient departments able to secure higher payments. The hospital-owned offices often charge a “facility fee” to help cover hospital overhead. Several Republicans expressed interest in pursuing so-called site-neutral payment policies, which would reimburse hospital-owned outpatient departments the same as doctors’ offices. Rep. Jodey Arrington (R-Texas) noted that the issue is bipartisan, and had been part of the budget requests of the last two Democratic administrations. Last year, the Trump administration finalized site-neutral payment rules for physician-administered drugs in Medicare. While the executives defended the practice of charging facility fees and higher rates at these outpatient departments — citing additional regulations and caring for more complex patients — Hazen said “there could be certain procedures” where the gap in prices is “too significant and they need to be less.” Hazen broke from the pack of executives and said HCA Healthcare “would be glad to work with the committee” on targeted site-neutral payment policies. But some lawmakers expressed skepticism about the willingness to collaborate on future policy efforts. The panel grilled health insurance executives in January about their role in rising health care costs, and many of them pledged to work with Congress on solutions. “It’s been interesting to see what’s happened ever since [the January hearing],” Rep. Beth Van Duyne (R-Texas). “Of the five CEOs who testified, only one has continued to actively engage with my office to follow up on these comments.” Rep. David Kustoff (R-Tennessee), who also pushed site-neutral payment policies, asked New York-Presbyterian CEO Brian Donley whether he could tell a patient in advance what the facility fee would be for a routine service at one of the hospital’s outpatient departments. Donley, who noted he’d only been in the CEO role for 12 months, said his team could provide that information, but acknowledged he didn’t know the answer himself. (Prior to taking the helm as chief executive, Donley worked as the hospital system’s chief operating officer.) “We talk about price transparency a lot,” Kustoff said. “It’s important to every patient, and you’re unsure whether they would know what the facility fee is before getting a colonoscopy at your facility.” “We’re committed to making sure patients know the price,” Donley replied. What to watch: The site-neutral payment issue is important because it can save the government billions of dollars, making it an attractive inclusion in any large spending packages. Although the growing critique from lawmakers is notable, expect hospitals — which maintain significant power on Capitol Hill — to push back against any sweeping payment changes. | 
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