{"entity":{"id":"idea-cost-site-neutral-infusion","kind":"idea","name":"Pay the same for an infusion whether it is given in a hospital or a clinic","aka":[],"tldr":"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.","asOf":"2026-09-10","links":[{"label":"CMS: Hospital Outpatient Prospective Payment System","url":"https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["340b-program","financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-incentive-misalignment","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":3},"route":"/ideas/idea-cost-site-neutral-infusion/","neighbours":{"term":[{"id":"340b-program","kind":"term","name":"340B Drug Pricing Program","route":"/terms/340b-program/"},{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}]}}