Don't Push Hospital Clinics Over the Cliff

Unless you haven't read a newspaper or watched the news in weeks, you're aware of the intense, ongoing negotiations in Washington, D.C. to prevent the United States from going over the "fiscal cliff" -- the now ubiquitous term to describe the hundreds of billions in automatic middle class tax hikes and federal spending cuts scheduled to take effect in January that could push the nation's recovering economy back into a full-blown recession.

Invoking the fiscal cliff is no mere scare tactic. The threat is very real, and it cannot be overstated how many Americans would be adversely impacted. To avert this calamity, our elected leaders in Washington -- President Barack Obama and House Speaker John Boehner in particular -- must put aside huge ideological differences and reach an agreement that will likely include higher taxes on the wealthiest Americans and lower spending on cherished programs such as Medicare and Medicaid. Both sides must make uncomfortable concessions.

With the stakes so high, it's not surprising that such big-ticket items are on the negotiating table. And while there's no question an agreement will require significant spending cuts, there is one health care cut under consideration that should be taken off the table to ensure access to care for traditionally underserved urban, low-income communities: a Medicare funding cut to hospital outpatient clinics.

As longtime health care stakeholders, we embrace change that will improve health care delivery for the most vulnerable Americans. But not all change is good, and with the Affordable Care Act's promise of more efficient care and vastly expanded health coverage tantalizingly close, now is simply not the time to pursue a Medicare cut that will take health care access in the other direction.

Hospital outpatient clinics provide important "evaluation and management" (E/M) services, such as a comprehensive assessment of a patient's symptoms and a determination of the appropriate treatment or care plan. Make no mistake, this is essential, often lifesaving care. The Medicare program has long reimbursed hospital clinics at a higher rate than private physician practices for these services to reflect the significant cost differences between hospitals and doctor's offices, including general overhead, caring for the uninsured, employing translators and social workers, emergency departments and myriad 24-hour standby costs.

But some fiscal cliff negotiators want to reduce Medicare E/M payments to hospital clinics by a staggering $6.8 billion to equalize them with the lower rates paid to physician offices. Perhaps years down the road, when we have a far more stable health care landscape, such payment parity would make sense. But not right now. And especially not after hospitals already accepted $155 billion in cuts over 10 years to help fund the Affordable Care Act.

In addition to the very real cost differences mentioned above, cutting hospital-based clinics so drastically would ignore the indispensable role they have long played in the nation's health care delivery system. For decades, hospital clinics have provided the primary -- and sometimes only -- access to physicians in the nation's underserved urban and rural communities. As these communities know all too well, most private physician practices do not accept Medicaid and won't treat the uninsured because it's simply not financially feasible for them to do so. So these vulnerable populations get their medical care at hospital clinics. For many, it's the only "doctor's office" they've ever known.

A $6.8 billion funding cut ignores these realities and would almost certainly force many hospital clinics to shut their doors at precisely the time when the success of health care delivery reform depends on hospitals enhancing their outpatient services to reduce avoidable hospitalizations and implement reforms, such as medical homes and accountable care organizations. As important as reducing the nation's deficit is, it should not deprive millions of Americans of their singular lifeline to quality health care.

America has always been defined by the compassion with which it treats its neediest and most vulnerable residents. By that important measuring stick, any fiscal cliff deal struck in Washington should not include a cut that would devastate hospital outpatient clinics. Because that would push access to care over the cliff