Site-of-service element could hurt practices

Pay falls for procedures done outside practice

HCFA’s new fee schedule changes will affect medical groups performing high volumes of work in such facility settings as hospital outpatient departments (HOPDs), ambulatory surgical centers, and skilled nursing facilities.

For those procedures currently subject to differential payment depending on where the procedure is performed, the fee schedule discounts all practice expense values by 50%. However, as of Jan. 1, the site-of-service differentials will be CPT code-specific, with some discounts less than 50% of the practice expense value—and others much greater.

When fully phased in, the ultimate financial impact on facility-based practices is likely to be substantial, contend organizations like the Medial Group Management Association in Englewood, CO. As such, depending on service mix, hospital-owned practices that have been structured to qualify as part of a HOPD could be vulnerable to big payment swings.