# Pay the same for an infusion whether it is given in a hospital or a clinic

Source: https://onco.cc/ideas/idea-cost-site-neutral-infusion/  
OnCo record `idea-cost-site-neutral-infusion` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The same chemotherapy infusion costs payers and patients more in a hospital outpatient department than in a doctor's office; paying one rate would stop hospitals buying clinics to charge the higher price.

## Summary

Hospital outpatient departments are paid under a separate, higher fee schedule and can add facility fees. As hospitals have acquired community oncology practices, infusions have moved to the dearer setting without any change in what is given. Site-neutral payment sets one price for the same service; Medicare applied it to clinic visits in 2019 and Congress has repeatedly considered extending it to drug administration.

## Fields

- Kind: Idea
- Last checked: 2026-09-10
- Hypothesis: Site-neutral payment for chemotherapy administration and imaging will cut Medicare and patient spending for those services by at least a fifth in hospital-owned sites without measurable change in safety or access.
- Rationale: The clinical service is identical; the price difference is a payment rule. Medicare's 2019 clinic-visit change reduced spending as modelled.
- Proposed test: Phase in site-neutral rates for infusion codes in Medicare and track spending, patient coinsurance, infusion volumes and hospital acquisitions of practices against the prior trend.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- CMS: Hospital Outpatient Prospective Payment System: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

## Connected records

- terms: [340B Drug Pricing Program](https://onco.cc/terms/340b-program/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)

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