Torture Victim Protection Act of 1989

This bill, S. 1629, the 'Same Care, Lower Cost Act,' amends Section 1834 of the Social Security Act to implement site-neutral payments for certain Medicare fee-for-service items and services furnished in ambulatory settings, beginning in 2027. The Secretary of Health and Human Services will identify at least 66 ambulatory payment classifications (APCs) for site-neutral payments, meaning hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs), and other appropriate settings will receive the same payment rate for these services. This eliminates the historical higher reimbursement rates for HOPDs for identical services. The money trail indicates a direct reduction in Medicare payments to HOPDs. The bill explicitly states that payment under Part B for identified services will be made at the 'applicable site neutral payment rate.' This mechanism directly reallocates Medicare dollars from higher-cost HOPD settings to a standardized, lower rate, effectively reducing the overall Medicare spend on these specific services. Hospital systems that heavily rely on HOPD revenue for these identified services will see a direct decrease in their top-line revenue from Medicare. Historically, efforts to equalize payment rates across different care settings have faced significant opposition from hospital groups. The Bipartisan Budget Act of 2015 included provisions for site-neutral payments for new off-campus HOPDs, which began implementation in 2017. This prior action led to a reevaluation of hospital expansion strategies and a focus on cost efficiencies. While specific stock movements from the 2015 act are complex due to broader market factors, the trend has been towards increased scrutiny of HOPD reimbursement. This bill expands the scope significantly beyond new facilities. Specific losers include large hospital operators with extensive outpatient networks, such as HCA Healthcare ($HCA), Universal Health Services ($UHS), and Tenet Healthcare ($TEN). These companies derive substantial revenue from HOPD services, and the mandated site-neutral payments will reduce their Medicare reimbursement for a significant number of procedures. Conversely, ambulatory surgical centers (ASCs) and physician groups that operate them stand to gain as the payment disparity for certain services is eliminated, making ASCs more financially attractive for Medicare patients and providers. The bill does not specify a dollar amount for savings but mandates a structural change in payment methodology that will reduce payments to HOPDs. This bill has been introduced and referred to the Committee on Finance. If it progresses through committee and passes both chambers, it will become law. The site-neutral payments are scheduled to take effect in 2027, providing a lead time for hospitals to adjust their operational models. The Secretary will identify the specific services for site-neutral payments, with consideration given to Medicare Payment Advisory Commission (MedPAC) recommendations.