Relates to fair pricing for low-complexity, routine medical care

Showing the cosponsors who are on Agora, A to Z. The official record may list more.

• Democratic81

Shown in neutral colors by design; Agora is non-partisan.

◆ The sponsor's argument

Why Liz Krueger says this is needed

Across the nation and in New York State, high hospital prices are driv- ing unsustainable increases in healthcare costs. These cost increases threaten affordability for New Yorkers and squeeze worker wages. While hospital spending increased by 97% from 2007 to 2020, average hourly wages only increased 15% in that same period. These steadily increasing amounts New Yorkers are paying for healthcare are not yielding more care or better health outcomes in return. Instead, high prices are reflective of hospital market power and consol- idation. With almost 60% of doctors' offices now owned by hospitals or corpo- rations, there has been an outsized growth in healthcare costs ass ociated with outpatient services that were traditionally performed in a doctor's office but are now being charged at higher hospital level pric- es. Essentially, the service and the quality of care are the same, but patients are paying more, in some cases just because a hospital owns the building. Site neutral payment policy aims to reduce unnecessary and inflated healthcare costs by equalizing the payment rate across "sites" of service (hospital outpatient departments, doctors' offices, ambulatory surgical centers, and other outpatient settings). Site neutral payment policy was initiated as part of the Medicare program, which set site- neutral payments for routine evaluation and management (E&M) services, such as a 15-minute wellness visit. Recent federal initiatives have sought to expand site neutral payment policy. The Fair Pricing Act is based on applying site neutral payment policy to a limited number of medical services that are appropriately delivered in the lower-cost site, which is an outpatient setting, including a doctor's office or ambulatory surgical center, depending on the service. Hospital outpatient departments are generally higher-priced. The services covered under the Fair Pricing Act are the same that Medicare's Payment Advisory Commission (Med PAC) identified in its recommendation to Congress to enact site neutral payments for services safe and effec- tive to perform in a doctor's office or other outpatient setting, and which had primarily been performed in doctors' offices prior to recent consolidation trends. Examples of such services include clinic visits, gynecological procedures like a pap-smear, certain skin procedures, such as laser treatments; drug administration procedures such as vaccines or infusion drug administration; and imaging procedures, such as X-Rays, ultrasounds, EKGs and MRIs. The site-neutral payment policy applies to all patients and programs except those paid for by Medicare, which sets its own rates at the federal level. The site-neutral payment policy will not apply to Feder- ally Qualified Health Centers (FQHCs),PPS cancer hospitals, public hospitals, federally designated critical access hospitals, federally designated sole community hospitals, rural emergency hospitals, and safety net hospitals, which are exempt. The Fair Pricing Act offers a unique and much needed remedy for New Yorkers' continuously rising healthcare costs by capping prices for routine services at 150% of Medi- care in order to lower health bene- fit expenses for payers and make healthcare more affordable for patients. This price cap level is set above the average prices charged by doctors' offices for the applicable services but below high hospital price levels for the applicable services, thus aiming to bring payment levels in other sites of service closer in line with doctors' office rates. By placing guardrails on healthcare pricing for routine services, regardless of where these medical services are provided, New York State can interrupt consolidation and corporatization incentives in health- care; protect patients - both insured and uninsured - from excessive and arbitrary prices; and promote a fair and affordable economy for taxpay- ers, employers, and workers alike. By limiting site-based price differences for the applicable services

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.