Patients who receive non-emergent medical care in a hospital outpatient department are more likely to be minority, poorer and have more severe chronic conditions than patients treated in physician offices, according to an American Hospital Association (AHA) report.

KNG Health Consulting, a health economics and policy consulting company, prepared the report for the AHA.

The authors mentioned that Medicare pays different amounts for the same procedure depending on the setting of care. Congress is considering a proposal that would make the payments for some services the same in hospital outpatient departments or physician offices, which would decrease the rates paid to hospitals.

In this study, the authors wanted to determine if patient characteristics differed at hospitals and physician offices, which could lead to differences in costs and care. They analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They measured patient severity and complexity using the Charlson Comorbidity Index and examining their prior utilization.

The report found that compared with patients who visit hospital offices, those who receive care in hospital outpatient departments are:

• 1.7 times more likely to be black or Hispanic
• 2.5 times more likely to be uninsured or covered by Medicaid
• 1.8 times more likely to be eligible for Medicare and Medicaid
• 1.7 times more likely to leave in areas with a mean annual income below $33,000
• 1.8 times more likely to live in high poverty areas
• 1.5 times more likely to live in areas with low rates of college education

Patients in both groups had a similar number of chronic conditions, but patients in hospitals had more severe chronic conditions as measured by the Charlson Comorbidity Index.

Further, Medicare patients seen at hospital outpatient departments had higher Charlson scores and made more previous visits to acute care hospitals and emergency departments.

“To the extent that these differences result in variations in the cost of care, site neutral payments may have adverse effects on patient access to care,” the authors concluded.

Read the AHA report here.