Patients treated for nonemergency services in hospital outpatient departments (HOPDs) are sicker and more likely to be from low income areas compared to patients receiving the same care in physician offices, according to a study prepared for the American Hospital Association by KNG Health Consulting, LLC. The study examined the differences in the two types of care facilities so that Medicare payment reforms can be more accurately developed in light of the different kinds of care challenges that HOPDs and physician offices face.
The study was designed to evaluate the differences between the patients served and the care provided for nonemergency services in HOPDs and physician offices because of proposed changes to Medicare payments that would cap payments to HOPDs for nonemergency services at the rate paid to physicians. The study specifically evaluated differences in patient populations between the two different types of facilities and the variance in the facilities’ care. The study evaluated differences in reasons for visits and the services, treatments, and medications ordered or provided. To conduct the study, KNG looked at the National Ambulatory Medical Care Survey (NAMCS) from 2008 to 2010 and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the same date range. The data analysis also included an evaluation of the 2012 Standard Analytical File of a 5 percent sample of Medicare beneficiaries.
Among the studies key findings were that patients in HOPDs were: 1.7 times more likely to be Black or Hispanic; 2.5 times more likely to rely on Medicaid, self-pay or charity care; 1.7 times more likely to live in a low-income area; 1.5 times more likely to live in a low-education areas; more likely to be burdened by more chronic conditions; and more likely to be hospitalized prior to receiving ambulatory care. Additionally, in terms of the differences in the care itself, when compared to physician offices, nonemergency care in HOPDs was: more likely to be delivered to a new patient, 1.2 times more likely to be for the receipt of treatment, more likely to include the ordering of additional treatment or services, and more likely to include the care of a nurse.