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so generally there has been consensus that CMS is still paying way too much for outpatient services generally thereamp;#39;s consensus that CMS is you know been doing this for a long time we need to finally rectify this so in fact medpac had reported to congress since 2013 theyamp;#39;ve been highlighting the rapid growth in hospital outpatient services and their spending relative to non hospital based services and medpac suggests that much of that rose it can be attributed to practice acquisitions and then the subsequent change to hospital provider based billing without any real change in costs that are warranted at higher payments and this issue has gotten a ton of attention in fact President Obama included a provision on-site neutral payments in his 2016 proposed budget proposal so the provision with lower hospital outpatient department payments to the relevant physician fee schedule or ambulatory surgical center rate now while the provision it might not make it into the final bud
