Relentless Health Value EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD
Mar 27, 2025
James Gelfand, President and CEO of the ERISA Industry Committee, discusses the evolving landscape of healthcare policies. He highlights the potential impact of Medicare site-neutral payments on hospital consolidation and the necessity for plan sponsors to adapt. Gelfand also sheds light on proposed HSA reforms, which aim to expand preventive care options for employees. The conversation addresses the challenges of high-deductible plans and emphasizes the importance of transparency and competition, aiming to lower overall healthcare costs.
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Understanding Medicare Site Neutral Payments
- Hospitals acquire provider offices to charge higher facility fees for the same services.
- Medicare site neutral payments aim to standardize payments regardless of care setting to curb consolidation and price inflation.
Hospital Price Markups and Facility Fees
- Hospitals mark up prices, charging far more for the same medical supplies and services.
- Eliminating facility fees where patients don't enter hospital premises can save significant costs.
Plan Sponsor Action on Site Neutrality
- Plan sponsors should not fall behind Medicare's purchasing policies to avoid higher costs from hospitals.
- Implement site neutral payment policies and steer patients to cost-effective care settings proactively.