Seniors could pay less starting in January for X-rays, ultrasounds, MRIs or other scans administered in a hospital under a proposal released Thursday by the Trump administration.
Medicare intends to reduce payments to hospitals for routine imaging services, putting them on par with what it pays doctor’s offices for the same services, according to two White House officials who detailed the proposed rule for NOTUS.
It’s the Trump administration’s most aggressive move yet to curb Medicare payments to hospitals, which receive two to four times more on average than doctor’s offices for identical outpatient procedures and who have played an outsized role in driving up health-care spending in the United States.
Past administrations and Congress have taken incremental steps to equalize hospital and doctor’s office payments, something called “site-neutral” payments. These efforts have engendered sharp opposition by hospitals, which argue they serve sicker, more complex patients and are subject to larger overhead and licensing costs than independent physician’s offices.
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The administration “is very interested in pushing the envelope on how far we can get on site-neutral because we think it is very good policy,” a White House official said.
Hospitals are increasingly acquiring independent doctor’s offices. When a doctor’s office is acquired, it can start billing Medicare at the higher hospital rate – even if the office isn’t physically in a hospital building.
The Centers for Medicare and Medicaid Services estimates the payment cuts would save the Medicare trust fund $9.5 billion over a decade. The rate cuts wouldn’t apply to scans in which the patient swallows or is injected with contrast agents like dyes to make blood vessels and tissues more visible.
The Congressional Budget Office has estimated the policy applied to all scans – including those in which contrast agents are used – would result in $7.6 billion in savings over a similar window.
Medicare patients would also save on out-of-pocket costs since they typically have to cover 20 percent coinsurance.
The proposal, which is part of a larger annual regulation on hospital outpatient payments, isn’t final and must go through a public comment period. It would go into effect Jan. 1.
Site-neutral payments have bipartisan appeal. Sens. Bill Cassidy (R-Louisiana) and Maggie Hassan (D-New Hampshire) introduced a broad framework for it in late 2024.
Last year, the administration applied “site-neutral” payments to drug administration services – like chemotherapy and other injections – provided at off-campus hospital outpatient departments.
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