Washington, DC — Today, the Dialysis Vascular Access Coalition (DVAC) has responded to the Washington Post Editorial Board's opinion on the best way to address concerns about hospital consolidation and its impact on Medicare's fiscal sustainability. 

The Post's proposal to reduce hospital rates to levels comparable to independent doctors' offices, like dialysis vascular access centers (VACs), is concerning to DVAC. While this specific  site-neutral policy  aims to address Medicare's fiscal sustainability, it ignores the significant cuts in Medicare reimbursement rates for office-based specialists. This policy change will not safeguard independent doctors' offices from additional closures. 

Washington Post Editorial: A fiscally responsible government cannot keep its hands off Medicare

“Medicare pays more for services performed on an outpatient basis at hospitals than it does for the same services done at physicians’ offices or ambulatory surgical centers. This makes no sense and creates an incentive for hospitals to buy up independent doctors’ offices that they then relabel as hospital facilities. Eliminating this discrepancy could save $141 billion over 10 years. Equally irrational are the different co-pays and deductibles traditional Medicare assesses for doctor visits and hospital stays. Replacing that system with uniform cost-sharing rates and an annual out-of-pocket cap would save $27 billion over 10 years.” (Washington Post, 3/23/2023)

DVAC continues to emphasize that as Congress works on fundamental Medicare reform, it needs to reevaluate how cuts, like those included in the MPFS for 2021 – 2023, are causing a domino effect through the entire healthcare system by further limiting patient options for care. To prevent hospitals from acquiring independent doctors' offices, the most straightforward solution for Congress and the Centers for Medicare & Medicaid Services (CMS) is to put an end to the ongoing cuts to office-based specialists under the MPFS that will persist until 2025. This approach enjoys bipartisan support and would offer improved protection to office-based specialists against further closures and acquisition by hospitals.

Dr. Dean Preddie, the DVAC Policy Chair, said, “While I am glad the Post is drawing attention to healthcare consolidation and the issues it poses, the Post’s editorial board misses a key piece of this story. Ongoing cuts to office-based specialists under the Medicare Physician Fee Schedule (MPFS) force providers to close, accelerating healthcare consolidation and further limiting patient options. Given these cuts to office-based specialists, the solution in this opinion would reduce Medicare hospital reimbursements rates to rates that are unsustainable for any healthcare provider. Instead, one of the most impactful things Congress can do is stop ongoing cuts to office-based specialists under the Medicare PFS, which are causing hospital acquisition of independent doctors’ offices.”